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Too Many With End-Stage Dementia Get Feeding Tubes
Date:2/9/2010

Medicare that pays for acute care, and these two systems don't work with each other very well."

Nursing homes have an incentive to send patients to hospitals, where someone else will pay for them and, as a result patients tend to be shuffled around.

"They often get very stressed out, have disruptive behavior, get medicines to treat that behavior, which leads them to developing bed sores and problems with eating, which leads to having a feeding tube inserted," Teno said. "Part of what we need to do is align the incentives to keep frail older dementia patients in the least restrictive setting that will provide the best medical care."

But much of the issue derives from lack of information or misinformation, as well as the sheer trauma of going through this process with a loved one.

For instance, many people are simply not aware that dementia is a terminal disease, as evidenced by a previous study that was published in October. "It is the fifth or sixth leading cause of death," Teno said.

And often, no one has a clear idea of what the patient would have wanted.

"Feeding is obviously a very emotional issue for families and . . . families have difficulty at times not pursuing feeding tubes," added Dr. Laurie Jacobs, vice chair of medicine at Montefiore Medical Center and Albert Einstein College of Medicine in New York City. "I don't think that the message is out there strongly enough that this treatment is not of benefit and patients don't live any longer, and treatment can impose quality-of-life issues on patients," Jacobs explained.

"When I talk to families, I say that really our goals here are to focus on what I call 'comfort feeding,' trying to maintain interaction with the family member and only to feed the patient as long as it feels safe and comfortable, and not to be in a situation shoveling food down them to try to maintain their weight," Teno said. "I have seen some really horrendous things ha
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