SPECIAL COMMUNICATION Tube Feeding in Patients With Advanced Dementia A Review of the Evidence

PATIENTS WITH ADVANCED DEmentia commonly develop difficulty eating, often when they become bedridden and dependent in all activities of daily living. They may resist or be indifferent to food, fail to manage the food bolus properly once it is in the mouth (oral phase dysphagia), or aspirate when swallowing (pharyngeal phase dysphagia). Enteral tube feeding is intended to prevent aspiration pneumonia, forestall malnutrition and its sequelae, including death by starvation, and provide comfort. We reviewed data about whether any type of tube feeding can accomplish these goals in this group of patients. Studies limited to patients with cancer, burns, trauma, dysphagic stroke, mechanical obstruction, critical illness, pediatric patients, or patients receiving ventilatory assistance were not considered. We did not include discussion of ethical issues, since our focus was on clinical evidence. We searched MEDLINE from 1966 through March 1999 and found no relevant randomized clinical trials comparing tube feeding with oral feeding in the severely demented. Thus, a metaanalysis was not possible; rather, we have presented a summary of the data available. In each section, we describe how articles were identified and summarize the findings. Our goal is to present the relevant data in a way that is useful to clinicians, patients, families, and perhaps policy makers.