Most people in the last stage of Alzheimer’s disease have difficulty eating and drinking. At this time, families may wonder if a patient needs a feeding tube. Families want to do everything possible for some- one who is ill. But they often get little information about feeding tubes. And they may feel pressure from doctors or nursing home staff, because feeding is simpler with a feeding tube. But feeding tubes sometimes do more harm than good.

Feeding tubes usually aren’t helpful for severe Alzheimer’s disease and tube feeding has many risks.

• It can cause bleeding, infection, skin irritation, or leaking around the tube.
• It can cause nausea, vomiting, and diarrhea.
• The tube can get blocked or fall out, and must be replaced in a hospital.
• Many people with Alzheimer’s disease are bothered by the tube and try to pull it out. To prevent that, they are often tied down or given drugs.
• Tube-fed patients are more likely to get pressure sores.
• Tube-fed patients are more likely to spit up food, which may lead to pneumonia a term called “aspiration pneumonia”.
• At the end of life, fluids can fill the patient’s lungs, and cause breathing problems.

So when are feeding tubes a good idea?

Feeding tubes can be helpful when the main cause of the eating problem is likely to get better. For example, they can help people who are recovering from a stroke, brain injury, or surgery. The tubes also make sense for people who have problems swallowing and are not in the last stage of an illness that can’t be cured. For example, they can help people with Parkinson’s disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

Caring for a person with severe Alzheimer’s disease

When caring for a person with severe Alzheimer’s disease, these steps can help with eating problems and other end-of-life concerns:

• Treat conditions that cause appetite loss, such as constipation, depression, or infection.
• Feed by hand. Ask the doctor about the best kinds of foods to offer and the best ways to feed by hand.
• Stop unneeded medicines.
• Schedule dental care. Badly fitting dentures, sore gums, and toothaches can make eating hard or painful.
• Consider hospice care. Many people with advanced Alzheimer’s disease qualify for hospice care if they have difficulty drinking and eating enough to keep their weight up. Hospice eases suffering and pain in the last six months of life. Hospice can be given in the patient’s home.

Plan ahead. Every adult should have an advance directive. It lets you say what kind of care you want and who can make decisions for you if you cannot speak for yourself. You can print your province’s advance directive form at: advancecareplanning.ca.

Conditions: Alzheimer’s Disease (AD), Dementia.

Procedures: Feeding Tube, Tube Feeding, Enteral Feeding, Gastric Feeding Tube (G Tube), Gastrojejunostomy Feeding Tube (JG Tube), Jejunostomy Feeding Tube (J Tube).