Feeding Tube: What Does It Do, Is It Time and How Will You Decide?

Many caregivers will be faced with these questions as they care for aging parents and other senior loved ones. What will you answer?

Unfortunately, this is a very personal decision that family caregivers may be faced with answering. Hopefully, you have been able to discuss this possibility and your senior’s desire for this course of treatment well before the need arose and before they were unable to express their wishes. If you haven’t, don’t delay!

Feeding tubes are actual tubes that are placed surgically into the stomach to provide nourishment and fluids to a person who is unable to take that nourishment on their own. This is usually recommended by  medical professionals in cases when there is a physical problem in the gastrointestinal system or a cognitive problem keeping them from eating.

Many seniors have thought this through on their own and have instituted some type of advance healthcare directive that will guide you making this tough decision. Do they have a living will that states whether or not they wanted to be kept alive with the use of tubes or other mechanical, artificial interventions? Do they have a DNR or other advance healthcare directive in place or have they completed the Five Wishes outlining their end of life wishes? If not, this option may be one you will have to decide to accept or reject. If that is the case, here is some information to consider when contemplating your choice.

Tube Feeding Facts

  • Approximately one third of skilled nursing facility residents with late stage dementia have had a feeding tube placed because they have forgotten how to eat. They are also used for patients recovering from brain injury or strokes.
  • Sometimes feeding tubes are recommended by a medical professional when a person is at risk for a swallowing difficulty, called dysphagia. In this case, any food or fluids ingested can be aspirated into the lungs resulting in pneumonia. Placing a tube does not correct the dysphagia and aspiration pneumonia on secretions such as saliva can still occur.
  • Feeding tubes can also be used by medical staff for administration of medications.
  • In some cases, but not all, feeding tubes can be uncomfortable for the senior. Tube placement is an important decision based on the patient’s condition. Often you can’t see the tube when it is not in use and can be covered with a senior’s clothing.
  • Some feeding tubes can be inserted through the nose into the stomach and are considered temporary compared to those inserted directly into the stomach. These are often used when the condition is reversible and the tube is easily removed.
  • Feedings via a tube can be done throughout the day, only at night or in small doses, called bolus feedings. Depending on the type of feeding schedule used, your senior may or may not need a feeding pump. Usually water is put through the tube before and after feedings or medications to keep the tube free flowing.
  • In some instances, a person can continue to eat by mouth with a feeding tube inserted. Often, the person is able to take some foods for pleasure while the tube feeding provides essential nutrition and hydration.
  • Tube feeding is often used for a short period of time for those facing a medical trauma to aid the recovery process. They have been used by the elderly patients to sustain life when inadequate nutrition for survival is achieved.
  • Your doctor, dietitian or other healthcare professional closely monitors the feeding for appropriate amounts to be sure adequate nutrition is being provided based on individual needs.
  • If a person is already actively dying, nutrients through a feeding tube will not be absorbed and this procedure will not prolong life.
  • For some elderly patients, feeding tubes may prolong life and provide precious time for families. However, feeding tubes can sustain life beyond the time when quality of life becomes a concern.
  • It is not as difficult as it once was to stop providing feeding tubes. Many courts recognize that nutrition is another medical intervention and do allow discontinuation.

Risks of using a feeding tube in late stage dementia

The risk of using feeding tubes is that they may be used for too long, which could lead to complications such as pneumonia. However, the benefits of using feeding tubes outweigh the risks.

Cost of Tube Feeding

Over longer term, the costs do add up and become expensive. Actual costs vary depending upon where you live and what services you receive from home health care agencies, nursing homes, hospitals, hospice programs, etc. The costs associated with placing a feeding tube include physician fees, hospital charges, supplies, equipment, training, travel expenses, meals, lodging, medication, physical therapy, occupational therapy, speech-language pathology, social work, dietary counseling, transportation, and many others.

Non-Surgically Inserted Feeding Tubes

A non-surgical insertion of a gastrostomy tube involves making an incision in the abdomen wall and inserting a soft plastic abdominal tube down through the abdominal cavity and out through the skin. This method has become less common because there are more effective methods available today.

Surgically Inserted Feeding Tubes

This method requires surgery to place a permanent opening in the abdominal wall. A surgical team makes two large cuts in the belly button area. One cut allows access to the inside of the body so doctors can insert a catheter into the esophagus. Another larger hole is made near the top of the chest allowing placement of a needle into the stomach. Through these openings, a thin flexible tube is placed into the stomach. This approach is more invasive and is typically used as a long term solution.

Alternatives to Tube Feeding

If you’re not completely convinced about tube feeding, there are also some alternatives that you can discuss with your medical professional

  • Careful Hand Feeding – This is a popular option when the caregiver has the time and the ability to carefully feed the patient.
  • Oral supplements – This involves giving liquids orally using syringes or special cups designed specifically for oral intake. The liquid is usually given several times per day. Some people prefer these over nasogastric tubes.
  • Parenteral Nutrition – This means getting nutrients intravenously. There are many different types of parenterals available depending upon what nutrient are needed. For example, if someone cannot tolerate fats then an amino acid solution would be administered instead. If there is no way to administer calories, glucose-containing solutions could be infused.
  • Enteral Nutritional Supplements – These are nutritional products that come in pill form and enter the body through the digestive tract.

Final Thoughts

Whenever a feeding tube is suggested or recommended by someone on your senior’s healthcare team, you should discuss all the possibilities. There are effects and risks of a feeding tube in addition to the risks of not placing one. You should discuss it with all family caregivers and, if able, your senior loved one too. What are the long term consequences and quality of life concerns that should be discussed before a tube is placed? If your senior has not executed any advance directives, ask yourself would your senior have wanted this to happen or would they want a natural end of life. Discuss with your doctor the what ifs such as what will happen if you want to stop the feeding in the future, what if the tube is dislodged by the senior and any other family concerns beforehand.

This is not a decision made lightly but one where you will need to weigh all the benefits and risks to your loved one. There is no right or wrong answer to this life changing question, but one that is right for your family and senior loved one. Get all the information you need to make the best choice possible for everyone.

Do you have more questions about this topic? We would love to address them for you and others who may also have similar concerns.