A client who lives in a long-term care facility is receiving intermittent enteral feedings

Tube Feeding in a Long-Term Care Facility

Feeding tubes for the elderly can be a very controversial topic.  Family members can easily become overwhelmed deciding whether a feeding tube is the best choice for a loved one in a nursing home. Long term care facility staff help navigate these decisions every single day. According to a report published in The Journal of the American Medical Association, “About one third of U.S. nursing home residents with advanced cognitive impairment have feeding tubes.”

Tube feeding, also called enteral nutrition, delivers liquid nutrition directly to a patient’s stomach or small intestine. A feeding tube can be placed through the nose and down the throat or it can be placed through a small abdominal incision directly into the stomach. A feeding tube can be helpful when the cause of the eating problem is likely to improve. This could include after surgery or severe trauma, neurological disorders, significant weight loss, cancer, certain bowel conditions, difficulty swallowing, or stroke. A tube feeding regimen provides all nutritional needs to meet recommended calorie goals calculated by a registered dietitian. Fluid goals are also met by adequate tube feeding and water flushes.

If a resident is able to swallow and can get adequate nutrition by eating, tube feeding is not recommended. No matter how long it takes a resident to eat, oral intake is still the preferred method over tube feeding.  In these cases, tube feeding can actually lead to a loss of function by not utilizing the chewing and swallowing mechanisms the resident already possesses. Tube feeding has many associated risks and there is no evidence that tube feeding prolongs or improves quality of life. Below are a few risks to consider when helping families or residents navigate the decision of feeding tubes.

1. Surgical risk- inserting a feeding tube requires surgery which is always a risk. As age increases, surgical risks go up as well.
2. Pressure injuries- Research finds that demented patients with feeding tubes are more than 2x likely to develop new pressure injuries. This is likely related to the requirement of residents to lay immobile in bed during feedings. For this same reason, those with existing pressure injuries are less likely to heal while they have feeding tubes in place.
3. Increased discomfort- Agitation and discomfort can be associated with tube feeds. This may lead to a patient trying to pull at their feeding tube.
4. Aspiration risk- Tube feeding has not been shown to prevent aspiration.
5. Infections- There are always risks of infection associated with tube feeds.
6. Malfunctioning tubes- leaks or other issues could result in another surgery to replace the tube.

An alternative to a feeding tube is careful hand feeding. This provides human contact and the enjoyment of tasting food. The American Geriatric Society states that hand feeding can be as beneficial as tube feeding. Oral supplements and fortified foods are also options to help residents meet calorie and fluid needs when intake is low.

Every person’s condition is unique and there may be situations where a feeding tube could truly be a beneficial treatment option for older adults. The important thing to remember is that there are always risks as well as benefits. Nursing home staff can work alongside families and patients to help them make informed decisions about tube feeding and end-of-life care. Ultimately, the patient’s wishes, comfort, and quality of life should take priority.

Resources:

The Journal of the American Medical Association, JAMA, July 2, 2009, pp. 73-80

Tube Feeding in US Nursing Home Residents With Advanced Dementia, 2000-2014

//jamanetwork.com/journals/jama/fullarticle/2544627

Feeding Tubes for Elderly: Pros and Cons. The Geriatric Dietitian //www.thegeriatricdietitian.com/feeding-tubes-for-elderly/

Tube Feeding Preferences Among Nursing Home Residents //www.ncbi.nlm.nih.gov/pmc/articles/PMC1497120/