What's Involved in Getting Your Family Member a Feeding Tube, or Depriving Them of One?

There is another approach to this problem. When people can't or won't feed themselves, it's sometimes possible to implant a feeding tube.

A feeding tube is a medical device for delivering food and fluid to the digestive tract. It's usually made of plastic or silicone, and no more than a few millimeters wide. The tube may be:

• Nasogastric, extending from the nose to the stomach.
• Nasojejunal, extending from the nose to the small intestine.
• Gastric, placed into the stomach through a small epigastric ("over the stomach") incision in the skin. This kind of feeding tube usually has a small button for opening and closing it.
• Gastrojejeunal, accessing both the stomach and the small intestine through an incision. This kind of tube is used when there is significant danger of aspiration of the contents of the stomach into the lungs or some other condition that prevents feeding directly into the stomach.
• Jejeunal, accessing the small intestine but not the stomach. The surgical procedure for this placement is not something that most people who have already accumulated other health problems, such as severe cardiomyopathy after heart attacks or breathing problems with Parkinson's can easily stand.

How often do people who have advanced dementia get feeding tubes? The answer is "Not often." In 2000, about 12 percent of people who had advanced dementia got this kind of intervention. In 2016, the percentage has fallen to about six, or one in sixteen people who have the problem. In the 1990's, the proportion had been about 30 percent.

There are some very practical reasons for this. One is obvious is you have dealt with an older person who has dementia but maybe not so obvious if you haven't. Many people who have dementia like to pull on things. If the elder would be constantly removing his or her own feeding tube, the trauma of constantly reinserting it could easily outweigh the benefits of nutrition and hydration.

Another problem is pressure sores. You may have some familiarity with the idea of bedsores. The pressure sores from a feeding tube are similar, except they occur inside the digestive tract. Just as bedsores can get infected, so can pressure sores. There can be horrific consequences of that kind of infection.

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A more consideration, however, is the need to come to terms with the reality that dementia leads to death. As the son of someone who went through this what I am confident in recommending to anyone is that it is a good idea to maintain hand feeding as long as possible. Food is one of the last pleasures in the lives of people who are losing their battle with dementia. As long as you can, get your loved one the foods they want.

But it's also a matter of how long they can enjoy them. Putting food in a person's mouth is pointless if they can't chew it, or they don't know what to do with it. Even when someone has dementia, the aroma of a food they associate with happy times seems to trigger happy memories. But you have to avoid giving your loved one the food and water that can make them literally choke.

Be as kind as you can as long as you can. Accept the reality of death. And be kind to those with whom you disagreed along the way.