Avoid tube feeding.

Hand feeding again preferred for patients with dementia

SUPPORTING EARLIER PUBLISHED REPORTS, another recently published report has come out in favor of hand feeding over tube feeding in persons with advanced dementia.

Dr. Muriel R. Gillick, of the Hebrew Rehabilitation Center for Aged in Boston, has written an article, "Rethinking the Role of Tube Feeding in Patients with Advanced Dementia," which appeared in the January 20 issue of The New England Journal of Medicine.

A similar article appeared in the October 13, 1999 issue of the Journal of the American Medical Association, as reported by Contemporary in our December 1999 issue (see "Wrong medicine" in that issue).

"The use of feeding tubes in persons with dementia is thought to prolong life," Gillick writes. "In fact, however, it has been remarkably difficult to demonstrate any difference in longevity between patients with feeding tubes and those without tubes."

Difficulty with eating usually indicates the final phase of the uniformly fatal illness, she writes.. Gillick strongly recommends feeding advanced dementia patients by hand, as did the authors of Journal of the American Medical Association piece, who found that tube feeding might actually cause adverse effects such as aspiration pneumonia and local infection.

"When tube feeding is used as a permanent alternative to oral feeding, patients are deprived of the enjoyment derived from eating," Gillick writes. "Feeding by hand is an act of nurturing that cannot be accomplished by hanging a bag of nutrients on a pole for delivery through a tube."

The Alzheimer's Association also supports hand feeding, says Stephen McConnell, PhD, vice president of program and public policy for the organization. But as he pointed out in December's Contemporary interview, tube feeding is considered skilled care and eligible for Medicare reimbursement, while hand feeding is not and requires staff members.