“Comfort Feeding” for Advanced Dementia

The New York Times published an article on physicians from Brown University who are advocating a new middle ground for people living with end-stage dementia, who are at high risk of aspiration: “comfort feeding”. Although I’m not crazy about using the word “feeding” with human beings, I think this is an important concept that deserves wider application.

When swallowing problems develop late in the course of dementia, it has been common practice to use a feeding tube to try to prolong life. Families and care staff alike have long expressed concern that the person not “starve to death”.

But feeding tubes have been seriously challenged by medical studies, which show: (1) feeding tubes do not prolong life in most cases of degenerative dementia, (2) they do not improve comfort, and actually can increase discomfort, (3) they do not prevent most aspiration pneumonias, (as the bulk are caused by aspirated oral secretions, not food and drink), and (4) they often lead to staff applying sedation and/or restraint, due to the distress they can cause.

On the other hand, an advance directive for “no artificial feeding/hydration” usually leads staff to stop offering food and fluids when aspiration risk is high, which can be a quality of life issue for many people who still maintain awareness and a desire to taste food.

As a solution, Brown’s Dr. Joan Teno advocates careful hand-assistance with modified foods, as tolerated, for such people. This requires a qualified assistant (usually a nurse) and may be time-intensive, as some people need up to an hour to take in a desired amount of food.

This is a comfort care approach. The goal is not to provide a full nutritional complement – the dementia has moved beyond this point. The goal is to continue the beneficial comfort effects of being able to taste and smell food and have close interpersonal contact, up to the end of life.

This will no doubt trigger the usual liability concerns, but it seems to me to be the right thing to do.

Here’s the article: \”Comfort Feeding\”

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