Choosing Wisely:

Don’t recommend percutaneous feeding tubes in patients with advanced dementia.

Rationale and Comments: Careful hand feeding for patients with severe dementia is at least as good as tube feeding for the outcomes of death, aspiration pneumonia, functional status, and patient comfort. Food is the preferred nutrient. Tube feeding is associated with agitation, increased use of physical and chemical restraints, and worsening pressure ulcers.
Sponsoring Organizations:
  • American Geriatrics Society
  • American Academy of Hospice and Palliative Medicine
  • Sources:
  • Randomized controlled trials
  • Disciplines:
  • Gastroenterologic
  • Geriatric Medicine
  • References: • Gabriel SE, et al. Getting the methods right–the foundation of patient-centered outcomes research. N Engl J Med. 2012;367(9):787-90.
    • Teno JM, et al. Do financial incentives of introducing case mix reimbursement increase feeding tube use in nursing home residents? J Am Geriatr Soc. 2008;56(5):887-90.
    • Teno JM, et al. Decision-making and outcomes of feeding tube insertion: a five-state study. J Am Geriatr Soc. 2011;59(5):881-6.
    • Palecek EJ, et al. Comfort feeding only: a proposal to bring clarity to decision-making regarding difficulty with eating for persons with advanced dementia. J Am Geriatr Soc. 2010;58(3):580-4.
    • Hanson LC, et al. Improving decision-making for feeding options in advanced dementia: a randomized, controlled trial. J Am Geriatr Soc. 2011;59(11):2009-16.

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