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
