NEW YORK (Reuters Health) – Despite the fact that up to one third of patients with severe dementia receive enteral tube feeding, evidence is lacking that this practice prolongs survival or improves quality of life, according to a report in the April 15 online issue of the Cochrane Database of Systematic Reviews.

“In fact,” lead author Dr. Elizabeth L. Sampson notes in a statement, “some studies suggest that tube feeding may have an effect opposite to the desired and actually increase mortality and morbidity and reduce quality of life.”

By searching multiple healthcare databases, Dr. Sampson and associates at the Royal Free & University College Medical School, London, identified seven observational studies comparing groups of patients with dementia who did and did not undergo enteral feeding.

Of the 1821 subjects, ages 63 to 107 years, 409 received enteral feeding. Clinical indications included inadequate oral intake, weight loss, refusal to eat, and dysphagia.

None of the studies found a significant association between decreased mortality risk, nutritional parameters, or incidence of pressure ulcers and enteral feeding, the review indicates, and none evaluated quality of life or physical functionality.

One study identified an increased incidence of aspiration pneumonia with tube feeding and a greater likelihood of requiring physical restraint to avoid extubation. Another reported a case of intra-abdominal abscess resulting in death associated with a percutaneous tube.

Dr. Sampson’s group notes that enteral tube feeding is often initiated to avoid “starving” the patient to death. However, “evidence from other terminal illnesses suggests that refusal of food and water is not painful.”

Because these patients cannot give informed consent, they continue, “this highlights the potential role of advance care planning and decision making to maximize the delivery of high quality and appropriate care to individual patients within this vulnerable group.”

Due to the heterogeneity of the population and range of outcomes, the investigators were unable to conduct a meta-analysis or to identify bias. They strongly urge prospective research on this topic that includes large samples, precise diagnoses, potential confounders, and clinically important outcomes, including quality of life.

”Consideration should be given to mandatory reporting requirements,” they add.

Reference:
Cochrane Database Syst Rev 2009;2.