Saturday, October 23, 2010

Comfort Feeding for Dementia Patients

A friend of mine was shocked and upset when he visited his mother recently. She has dementia and has only been in a nursing home a few weeks. Walking into her room, he found her being fed with a feeding tube. Although he is her primary caregiver, this decision had been made without his knowledge or approval.  His mother is in relatively good physical health for her age, and he felt this had been done because tubal feeding would be easier for the staff. He immediately set about changing her feeding back to hand feeding.

Although evidence suggests that feeding tubes do not improve survival or reduce risk of aspiration, they are used often on nursing home residents with dementia. Unfortunately, most residents have no documentation regarding their wishes on the use of artificial hydration and nutrition. One reason is that families may confuse the order of “do not feed” with meaning no artificial feeding. Nursing home staff members fear that they will be in trouble if residents lose weight and a feeding tube hasn’t been used.

The “Journal of the American Geriatrics Society” addresses these concerns. One solution is having residents’ wishes regarding goals of care clearly stating an individualized feeding plan that supports the residents’ comfort and wishes. The phrase “comfort feeding only” through careful hand feeding presents an alternative to imposed orders to end artificial hydration and nutrition.

Frances Shani Parker, Author


  1. Peg tube or NG tube?

    Obviously, the nursing home cannot make the decision to send the patient out for surgery to have a peg tube inserted without getting his approval, if he is the responsible party. If that is what happened, the facility is definitely out of compliance with the federal requirements.

    If they were trying an NG tube, that is a little better, but still all discussion should have taken place with the sponsor.

    Was there another sponsor who had a POA?

  2. Thanks for your comments clarifying the types of feeding tubes. I don't know which type was used, but we both knew the procedure was incorrect.

    My friend, an only child, had put his mother in the nursing home because his father, who had been her primary caregiver, had recently died. He had been visiting his mother after work almost daily. Finding her like that being fed with a feeding tube was traumatic for him.

  3. Yes I think there should be a careful and clean statement of the kind of feeding that has to be adopted and approved by the guardian who is interested in the patient if both the ways stand to mean the same.

  4. Kelvin TsangSeptember 16, 2012

    I totally agree all so respecting to our lovers who have difficulty in swallowing or dysphagia. Use of tube feeding as artificial nutrition and hydration is not humanity. However, prior to considering "Comfort Feeding Only", we should confirm there is a care-giver who can spend long time for feeding. Nursing home or old age home may not be a good place where inadequate manpower may cause our lovers malnutrition eventually if we insisted on refusal of using tube feeding.