Alzheimer's Disease - Is tube feeding the right way to go?

Source: Dr. Robert Griffith - Journal of American Geriatric Society:

The use of tube feeding for adults with terminal illness is growing rapidly. There are several methods of artificial feeding, but the one most commonly used today is percutaneious endoscopic gastrostomy (PEG). Unfortunately, there is very little evidence so far to show that it's use leads to improvement in the nutritional and general health status of terminal patients, or in their quality of life.

"Spouses, close relatives and caregivers of adults with terminal illnesses, such as Alzheimer's disease, really need this sort of information, to help them handle difficult questions about what is best for their loved one." says Dr. Griffith.

Placement of a PEG tube requires a surgical procedure whereby an instrument (a gastroscope) is passed down into the stomach and some air is introduced. Then, under local anesthesic, a puncture needle containing a guide thread is passed through the abdominal wall into the stomach. Using the gastoscopy forceps, the thread is withdrawn from the stomach, together with the gastroscope, through the mouth. The end of the thread is then attached to a catheter, which is pulled gently through the mouth, the gullet and stomach wall to the exterior of the stomach, until it's retaining disk is against the inside of the stomach wall keeping the tube in place. (American Journal of Gastroentoerol, 2000, vol. 95,pp 1472-1475)

Now, some physicians in Indiana, have measured the outcome in a group of people treated with PEG. As over half the subjects couldn't communicate with the nurse, direct observation and input from close relatives or caregivers was used to determine the subjects physical condition and quality of life.

The average age of the subjects was 79, and just over half of them were women. They had, for the most part, severe advanced chronic disease, and many were acutely ill on top of that. The main reasons for using the tube feeding was the inability to consume food and water because of: stroke (41%), Alzheimer's disease or other progressive dementia (35%), cancer (13%), or something else (11%).

Thirty days after tube feeding was started 22% of the subjects had died, and by 12 months after the feeding started, 50% had died. Persons with a diagnosis of dementia had a signficantly higher mortality rate than those in the other categories.

Comparisons made at 2 months and at 4 months into the study showed that there were essentially no relevant changes in the health or quality of life of the subjects reported. Over 70% of the subjects had no significant improvements over the 4 month period. Most subjects reported at least one physical problem (pain, discomfort, nausea) due to the PEG.

It seems clear that tube feeding does not lengthen life in these patients, at least to a significant extent. By the time patients are serious candidates for tube feeding, they are usually so ill that any benefits obtained are almost too small to be recognized; on the downside, PEG placement is associated with discomfort and side effects.

Be sure to discuss your family members' needs and wishes with your physician and other family members so you can make an informed decision regarding this and other medical procedures if the need arises.

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