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, whether 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 nursing home residents with dementia have had a feeding tube placed because they have forgotten how to eat.
- Sometimes feeding tubes are recommended 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 for administration of medications.
- In some cases, but not all, feeding tubes can be uncomfortable for the senior. 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 in the elderly 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, 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.
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.