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Tube
Feedings Harm Many Demented Patients
CHICAGO –
AP World News via NewsEdge Corporation: Feeding tubes
usually do little good for mentally incapacitated patients and
may cause problems they are meant to prevent, such as lung
infections and early death, researchers say. The report could
have broad implications for millions who have Alzheimer’s
disease and those who care for them. The illness, the leading
cause of dementia, is expected to become more widespread as
the population ages in most nations.
Unlike feeding
tubes, careful hand feeding lets demented patients live as
long as other nursing home patients, the authors concluded.
That runs contrary to some U.S. nursing home practices and
Medicare reimbursement guidelines for demented patients,
Alzheimer’s advocates say.
"The
widespread practice of tube feeding should be carefully
reconsidered, and we believe that for severely demented
patients, the practice should be discouraged," wrote the
study’s lead author, Dr. Thomas E. Finucane, an associate
professor of medicine at Johns Hopkins University.
The authors
reviewed more that six dozen medical studies about feeding
tubes published over the past 33 years. Their findings appear
in the October 13th Journal of the American Medical
Association.
Feeding tubes,
typically inserted through the nose or abdomen, are used in
roughly 10% of dementia patients in nursing homes in the
United States, though the practice varies widely, Dr. Colleen
Christmas, a co-author, said Tuesday. The authors found no
evidence to support the reasons usually given for using the
tubes: preventing early death from malnutrition, averting lung
infections caused by inhaling food, and relieving suffering.
On the
contrary, tube-fed patients typically died within a year, got
higher rates of lung infections and became so agitated that
they required restraint or sedation, studies showed. Experts
on dementia who were not involved in the review praised it as
an important contribution toward overturning misconceptions.
"The
benefit of this article is that it’s starting to really
question this almost knee-jerk response: "The person’s
not eating, therefore we must institute tube-feeding,"
said Dr. Robert McCann, Chief of Medicine at Highland
Hospital, an affiliate of the University of Rochester in
Rochester, New York.
Advanced
dementia is a terminal illness that robs people of mental
abilities such as the memory of how to chew and swallow, and
some suggest it is better to let such a patient go without
food or water.
"Our
position is that it is ethically permissible at any point, but
particularly in the advanced stages of dementia, to withdraw
or withhold artificial food and hydration," said Stephen
McConnell of the Alzheimer’s Association. He said the policy
dates back eight or nine years.
[Copyright
1999, Associated Press]
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