You receive a swallowing referral for a patient living with advanced dementia. A VFSS reveals severe pharyngeal impairments that negatively impact swallowing safety. Given the patient’s poor physical mobility and dependence for feeding and oral hygiene, they are judged to be at high risk of dysphagia-related aspiration pneumonia. Sigh. Now what? 
 

Medical SLPs are often faced with helping families navigate this difficult decision, which can then trigger a discussion between the POA and the medical team about the patient’s clinical situation and goals of care. Heavy, heavy stuff. 
 

When I have these conversations with physicians and family members, I often use resources like Choosing Wisely and the American Geriatrics Society Feeding Tubes in Advanced Dementia position statement. These resources can help inform key stakeholders about the risks and benefits of oral versus non-oral feeding. It’s also important that SLPs stay up to date on the information that goes into creating these resources.

Enter Davies et al.’s systematic review on tube feeding for people with severe dementia. This review provides the current state of evidence on this topic as of April 2021. Here are some key takeaways: 

• For one, the quality of the evidence was pretty low, with no randomized controlled trials, for example. 
• For the studies that were included, the authors concluded that there was no evidence that tube feeding in advanced dementia improves survival time, quality of life, nutrition, or caregiver outcomes.
• Likewise, they found no evidence that tube feeding in advanced dementia decreases pain, behavioral and psychological symptoms of dementia, or the risk of pneumonia. Tube feeding in advanced dementia may, however, increase the risk of developing pressure ulcers.

“Tube feeding may not increase the length of time people with severe dementia live compared to no tube feeding. The risk of developing a pressure sore is probably higher with a feeding tube than with no tube.” 

 

– Davies et al., 2021

And if you’ve kept up with our reviews on dementia, this information is consistent with what you already know about feeding and nutrition methods in this population. We'll continue to keep you informed on this complex issue. For now, it’s encouraging to see that the overall position on tube feeding in advanced dementia hasn’t changed much with new research. Finally, check out this open access conversation and decision aid that these authors also shared with us! 

Davies, N., Barrado-Martin, Y., Vickerstaff, V., Rait, G., Fukui, A., Candy, B., Smith, C., Manthorpe, J., Moore, K., & Sampson, E. (2021). Enteral tube feeding for people with severe dementia. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD013503.pub2