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Monday, July 18, 2011

Are Feeding Tubes Always The Solution?

Several million seniors are living with advanced dementia, and most–up to 85 percent–will develop problems eating.

While a third of those patients will receive feeding tubes, new research shows that there are risks involved, and that some patients’ families are not adequately informed about the potential complications.

Dr. Joan Teno told Here & Now‘s Monica Brady-Myerov that many families surveyed said they felt pressured into giving a loved one a feeding tube, even though no one had discussed the risks with them.

The tubes need to be inserted surgically and Teno said they can sometimes lead to blockages and pneumonia.

Alabama resident Martha Crowther was told by a doctor to put her mother on a feeding tube after her mother had had a stroke and stopped eating.

“They told me for her to continue living, she would have to have a feeding tube,” she said.

But after talking to a geriatrician, Crowther decided her mother’s quality of life would be greatly reduced with a feeding tube, and she decided to forgo the service for her mother.

Crowther’s mother was able to start eating again on her own shortly after Crowther’s decision.

Dr. Teno says that frequently doctors are under time constraints and quickly recommend feeding tubes, without trying hand feeding first.


  • Dr. Joan Teno, director of The Gerontology and Healthcare Research Center at Brown Medical School
  • Martha Crowther, who chose not to put her sick mother on feeding tubes

Please follow our community rules when engaging in comment discussion on this site.
  • Mark K Reed

    This segment does somewhat of a disservice to the public’s understanding of this issue by the repeated reference to a “surgical procedure”. The insertion of a thin (thinner than an ordinary drinking straw) flexible feeding tube through the nose into the stomach requires no instrumentation whatsoever, nothing sharp, no “instruments” or special tools. There are types of feeding tubes inserted thru the abdominal wall into the stomach which certainly would be a “surgical procedure”, but this type of tube does not sound like the subject of this discussion. If the placement of a nasogastric tube for feeding is to require a surgical consent then surely so also would the placement of every single intravenous catheter…..  I hasten to add and endorse the concept that placement of a nasogastric feeding tube, particularly if intended to play the major role in life support discussed on this segment, should indeed be thoroughly considered with full understanding of the patient and family members – there certainly are possible complications, hazards and alternate methods of care to be considered

    Mark K Reed, MD

  • Donnajd5

    My mother was 81 was well, and my sister and I were adamant that my mother not be inserted with a feeding tube, unfortunately I am in Texas and my mother was at my sister’s home in California.

    My brother’s overrode our decision and I was furious because it not only did not help my mother but she was in excruciating pain, and was on morphan,  and died three days later.  Moreover, my mother was very healthy, and had very slight dementia, and was eating with no problem.  It was purely for the doctors to get more money from the government.  I’m an still angry.

    Donna, San Antonio

  • Eleanor H.

    Thank you for airing this program on a very important topic, end-of-life care. Feeding tubes are undoubtedly a contributor to the high cost of Medicare, especially toward the end of life.

  • Pat Goodman

    Thank you.  I found the story about feeding tubes most enlightening.

  • Linda

    I am a speech pathologist. I have worked in long term care for seventeen years. We are the discipline that provides much of the expertise that would lead to a discussion with loved ones (health care proxies in particular) so I have participated in this process countless times.
    I find this reporting to be reckless. It is the opposite of my experience. First of all, the woman whose mother recovered from a stroke and rehabilitated her muscles for safe swallowing was completely unrelated to the topic of advanced dementia and it’s deteriorating effect on all the systems of the body. Second of all, not one doctor I have ever worked with ever demonstrated any consideration for the ease of the j ob done by the certified nurses aide. Remember it Isn’t The doctor who sits and feeds patients, it’s the nurses aide or the therapists. when dementia reaches a stage at which the patient can no longer safely coordinate the actions necessary for adequate nutritional intake we discuss S a team, the options. We have a responsibility to be compassionate but also to be objective. It isn’t our right to make quality of life decisions. That is the role of loved ones and we educate them as such.
    I write like a clinician because this is my vocabulary as an expert. But I have a compassionate way of leading this discussion with family. I addition, we have never recommended gastroenteral tube for any patient with advanced dementia. Never. We hold the opposite viewpoint we were painted with in this careless reporting. Dn
    DON’T make extra money off a tube and it doesn’t make patient care easier. W develop relationships with our long term, advanced dementia patients. W know how many sugars they like in their tea and we know their grand hi deems names if not the grandchildren themselves. The suggestion that we would ever, as a medical team, not include family is ludicrous and I am quite sure not even allowed.

    We generally don’t recommend a tube unless it will contribute to a better outcome. For example an adult whose stroke left them with limited control of their throat muscles for a period of months while they rehabilitate might be considered for a feeding tube to facilitate nutritional intake while keeping them free from pneumonia and free from the fear and pressure associated with eating under that circumstance. We are hyperaware of the risks involved, including a feeding tubes inability to prevent an aspiration pneumonia. Reflux leads to aspiration pneumonia in a measurable percentage of patients with feeding tubes. We care about easing the end of life as much as families and we take our responsibility to educate and counsel them with serious compassion.

    The most damaging thing this kind of reporting does is incite more doubt in the public about trusting caregivers. While these meetings often inspire a range of emotions from family our job is as much to help them understand the process as it is to present the options. If anything, doctors prefer not to use feeding tubes as options if they can avoid it and still maintain the patient’s safety.

    Remember, it takes a tremendous amount of genuine compassion to present families with any news about end of life considerations. It is not even necessarily the most troubling piece of that puzzle for families to put together. Sometimes families have their own dynamics that complicate the process for them. They can’t agree or can’t communicate about it. They might talk to people they know and trust instead of one of the people who actually care for their loved one and understand what is medically
    realistic. when families lose faith in the team of caregivers they are entrusting with their loved ones care, they tend to lose sight of their real struggle which should be focused on the mourning process that inevitably begins at this stage of dementia for these families.

    That is the danger of this misleading article.

  • Pietwrbrueghel

    When my 93 year old father was in a nursing home towards the end of his life, frail,losing his eyesight and hearing, he had had enough of life. A brilliant man who had survived the tenements of turn of the century New York City, worked his way through Junior High School , got a college degree at the then Free City University and went on to be a union organizer, soldier, and Secretary to a European delegate to the UN, he had had enough of life. When he stopped eating the doctor suggested that they place a feeding tube (directly through the abdominal wall). Even though he was so frail that to someone who did not know him he appeared to have dementia, I told the doctors that the decision was up to him. I explained the procedure to my father and told him that it might extend is life. he opened his almost blind eyes and looked at me and said, “What’s the point of that?” Then he said, “…and with the care they give here they are just as likely to attach that tube to the water bed and then where will I be?” He’d kept his sense of humor, and died a week later. It’s what he wanted.

  • Al Rodbell

    This was from an ER physician 

    You write that the researcher described doctors performing a surgical procedure by inserting feeding tubes without authorization …”I don’t know where you got the “without authorization” part, Al. That would be a battery, about which every physician is aware. The physicians referenced in the article you sent are undoubtedly authorized to perform the procedures. They discuss with the families what they (the families) think the patient would prefer, and then – if the families say, “Yes, (s)he would want you to place the tube” (which they almost always do) – they perform the procedure.The fact that the physicians “reap[] financial gain” is nothing new. Data for decades have shown that physician make recommendations that reflect their economic interests. I doubt that is unique to physicians.More to the point is that the issue relating to feeding tubes is just a small part of a much larger issue that pervades our health care system. (In fact, I just had a conversation on this topic less than an hour ago with the daughter of a 96 year old in our hospital.) Feeding tubes are no different than antibiotics or IV fluids. First of all, doctors only get paid when there are living patients on the wards. Probably more importantly, family members are always loathe to “pull the plug.” In fact, when I have these discussions and ask the kids, “Would you want to be kept alive like this?” the answer is almost always no. “Do you think your mom would want to be kept alive like this?” “No” is answered to that question as well. Then, when I ask, “Do you still want us to do everything to keep her alive?” the answer still comes back, “Yes.”Name removed.

     As I wrote back to the E.R. physician 

    In the audio of the interview at 1 min 31 sec, Joan Tino MD, the lead researcher, says, “We were shocked, that 14% of the people we surveyed just walked in the room and the feeding tube was there. No doctor had spoken to them” . And then Tino continued, “standards of medical practice suggest that written approval be given by patient or responsible party” I’m glad to hear that these are not merely suggestions, but criminal laws, that without informed consent, this is battery, and is treated as such by our judicial system.

  • http://www.facebook.com/fidafarhoud fida farhoud

    its  an important topic to discuss………………….it could be a useful solution:)

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Robin Young and Jeremy Hobson host Here & Now, a live two-hour production of NPR and WBUR Boston.

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