06/15/11

Weight loss is common in the elderly but sometimes is due to a terminal illness and can’t be prevented. When a person reaches the point where he/she can no longer eat, the physician may discuss options such as feeding tubes. These may be useful in some situations, but it is important to discuss the pros and cons, as well as the person’s advance directive or living will (his/her choices), before making a decision.

Tube feeding – through the nose or the stomach – may be useful when choking or swallowing problems prevent the person from eating, when the person has had a stroke or other brain injury, when the person has had recent head and neck surgery, when the person has a problem with his/her esophagus, or when the person is severely demented.

It is important to understand the truth about what tube feeding means. It is not without risks including infection and aspiration pneumonia. There is little proof that it does much to improve quality of life. For example, while you may worry that if your dying family member/friend can’t eat, he/she will be hungry and uncomfortable. But the truth is that most dying people are not hungry and actually are content with small amounts of food and liquid.

The decisions about tube feeding should be based on good information, the person’s condition, and realistic expectations about the likely results. While there are many issues to think about, you don’t have to make this decision alone. The physician is there to help you.

Questions to Ask Your Physician:

• How much is this likely to help my family member/friend? Will it make him/her more comfortable and/or help him/her live longer?

• What are the risks of side effects like infections?

• What are our options?

• What else can be done to keep my family member/friend comfortable?

What You Can Do:

• Make sure your family member/friend has an advance directive or living will that states his/her choices about things like tube feeding. Make sure his/her physician has a copy of this. Update it when there is a change in the person’s condition or a new diagnosis (such as cancer or dementia).

• Discuss the pros and cons of tube feeding with the physician.

• Work with facility staff to get the spiritual support you and your family member/friend need.

• Talk with staff about how to make your family member/friend as comfortable as possible at the end of life.

For more information:

• Tube Feeding Offers No Benefit for Critically Ill Long-Term Care Patients: tiny.cc/oyey7

• Download Your State’s Advance Directive: caringinfo.org/i4a/pages/index.cfm

• Advance Directives and Do Not Resuscitate Orders: familydoctor.org/online/famdocen/home/pat-advocacy/endoflife/003.printerview.html

• Feeding Tube Insertion: www.nlm.nih.gov/medlineplus/ency/article/002937.htm

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