living your best to the end

Dementia: Feeding tubes may add to risk of bed sores

 PEG or Percutaneous endoscopic gastric feeding tubes, long assumed to help bed-bound dementia patients stave off or overcome pressure ulcers, may instead make the wounds more likely to develop or not improve, according to a study. “We see a substantial risk of people developing a stage II and higher pressure ulcer. We believe these risks should be discussed with family members before a decision is made to insert a feeding tube in a hospitalized nursing home resident with advanced cognitive impairment.”  Joan Teno, MD, MS, the study’s lead author and a gerontologist and professor of health services, policy and practice in the Public Health Program at Brown University in Providence, R.I., said in a news release, “This study provides new information about the risks of feeding tube insertion in people with advanced cognitive impairment.” In this study, the researchers found that among patients who did not start with an ulcer (bed sore) , 35.6% of those with a feeding tube ended up with at least a stage II ulcer, compared with 19.8% of patients without a feeding tube. The researchers found that the chance of getting an ulcer was 2.27 times higher for people with feeding tubes than for those without. The risk of developing a more serious stage IV ulcer was 3.21 times higher for those with feeding tubes. Among patients who already had an ulcer, the researchers found that 27.1% of patients with a feeding tube experienced short-term improvement, while 34.6% of those without a feeding tube experienced healing in a comparable time frame. In a previous survey, three-quarters of physicians thought the nutrition delivered by feeding...

Hunger and thirst: our needs diminish as life ends

Planning for end of life for those with specific medial conditions: Not able to eat or drink “I have conversations every day about food and supplements for frail elderly and even those with early stage dementia.” Dr. Michael Gordon Geriatrician, ethicist, educator, speaker, author and Medical Program Director Palliative Care, Baycrest Centre for Geriatric Care There’s so much more meaning to food and eating than merely getting nourishment. Food represents caring, nurturing, contact, love. The decision not to feed via tube (PEG – via tube inserted into the abdomen or NG inserted up the nose ) or hydrate via intra-venvenous (IV) would seem, as Dr Gordon says: “abandonment of a basic need of a loved one” or, I’ve often heard described as ‘starving him/her to death.” As I’ve learned, this is a gross mis-representation of the reality of our needs as life comes to an end. Dr Gordon explains: “What most people don’t realize is that eating needs at the end of life are much different any other time. For example, in religions where fasting is part of the culture – such as Jews or Muslims – by the end of the day they’re tired, rather than hungry. However, if you’re well, at the end of the fasting day, the first food you smell or put into your mouth triggers the brain and body and you’re hungry. Not so in the later stages of life.” Feeding at the end of life  – whether by mouth or tube – comes with complications: agitation nausea, coughing  and aspirations – inhaling food into the lungs – which often results in pneumonia which...