Wednesday, January 2, 2013

Considerations about getting a feeding tube - dysphagia

I have only had one client who has been tube fed. Making a decision about tube feeding is a difficult one. The decision needs to be made with all of the information you can glean. The doctor may suggest it, or the patient may have questions about whether or not tube feeding is a procedure that they might be interested in.

If the patient cannot make the decision to due physical, psychological impairments, it is up to the family or those with Power of Attorney (POA) to speak to the physician and ask the right questions. For those with dementia, tube feeding may give more comfort to the doctors and the family than the patient. (Whistleblower: Dr. Kirsch: "I have already expressed in a prior post about why unnecessary PEG tubes are placed.") Once my late father was unable to feed himself meat and veggies, I would go in and feed him dinner every night. I bargained with him, as if he were two years old. I see now that this was undignified. He preferred desserts, and I should have listened to him more closely.

Disease Trajectory
If you have a disease in which the trajectory is clear, and predictable, it is a discussion you must have with your family in order for them to understand your wishes. Many people have strong feelings about this issue. Hopefully, you have done advance care planning as the doctor will ask if the person has had any prior discussions with loved ones about health care preferences in situations like these.

If you are making this decision for your loved one without any discussion, it is important to distinguish what it is they would want and what kind of quality of life they would ask for.

  • Will the treatment make a difference?
  • Do the burdens of treatment outweigh the benefits? 
  • Is there hope for recovery? If so, what will life be like afterward?
  • What do I value?
Tube feeding is not usually recommended when a person is:
  • permanently unconscious
  • terminally ill and near death
  • near death
  • not wanting to be tube fed, for any reason.

When is it called for?
  • When nutrition is insufficient, as documented through lab values, patient’s own report or clinical signs.
  • When hydration is insufficient.
  • When disease affects the muscles involved in eating: i.e. chewing, moving food in your mouth and swallowing.
  • When eating leads to fatigue and one has difficulty eating enough to sufficiently nourish your body.
  • When noticeable weight loss, malnutrition and dehydration are present.
  • When decreased energy and increased fatigue accelerates the progression of weakness.
  • When dysphagia (difficulty swallowing) occurs on a consistent basis.
  • When aspiration (food or liquid taken through the mouth going down the windpipe and into the lungs) is suspected. Aspiration pneumonia is a common issue for ill seniors. 

When Food intake drops below the recommended levels of the following servings per day:

  • 3 or more servings of meat or protein alternative.
  • 2 or more servings of milk or yogurt.
  • 5 or more servings fruits and vegetables.
  • 6 to 11 servings of grains and starches.
  • 4 to 7 servings of fats.

Deciding on a
feeding tube
(PDF)

I have found several resources

1. Deciding on a feeding tube (PDF) from St. Joseph's Hospital
2. FYI Feeding Tubes (PDF) from ALSA.org, it explains the different types:
  • Percutaneous Endoscopic Gastrostomy (PEG -through the skin into the GI tract through a hole in the stomach).
  • Nasogastric – NG tube, 
  • Jejunostomy – J-tube

Don't forget the cost:




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