Our mom is in a nursing home with dementia and emphysema. She’s losing weight, can’t walk, has fallen many times and is often taken to the ER. The home says we need to consider a feeding tube; would that help her?
There are two kinds of feeding tubes:
1) down the nose [called a Naso-Gastric Tube – NGT];
2) through the skin over the stomach [called a PEG – Percutaneous Endoscopic Gastrostomy].
The NGT is often placed for patients in the intensive care unit to give them liquid food such as “Ensure”, and can be left in for up to six weeks. Nursing homes do not use these because it’s too easy for patients to accidentally pull them out.
The PEG is a ‘permanent’ access for liquid food; but, it requires an anesthetic so it can be inserted through an incision. Since it is much more difficult to remove them, nursing homes prefer these. PEG’s can occasionally keep someone alive for years.
Many patients and medical staff have the mistaken belief that feeding tubes reduce the risk of aspiration – food going “down the wrong way” into the lungs. The reality is that the tubes actually increase the risk of aspiration pneumonia from 15% to 60%. That means, of every 100 seniors who do not have a feeding tube, each year 15 are ‘expected’ to aspirate; but, if they have a tube put in, 60 per 100 will aspirate!
Feeding tubes can be beneficial in two situations: 1) to “buy time” for someone with esophagus cancer when they can’t swallow anything; and 2) for those with a stroke and can’t swallow, who are hoping they will regain their swallowing ability in a few months.
For patients with dementia, feeding tubes are NOT recommended: studies show they do nothing to improve the quality of life, reduce the risk of bed sores, etc. For your mom, her dementia and emphysema are causing her to lose weight and fall. A PEG will not change that nor help her to have quality time with her family.
Your family needs to tell the facility that, because your mom has a terminal disease, you want only comfort care for her: keep her clean, dry, warm, let her eat what she wants, stop medications that don’t improve her comfort, don’t interfere in her end-of-life journey—and leave the rest up to God.
Many nursing homes are uncomfortable with this CTC [Compassionate Terminal Care] approach; having a hospice oversee your mom’s care in her final months might help ensure your goals for her comfort are followed.