Abstract

RICA ESCUIN, Mª Luisa de la; GONZALEZ VACA, Julia; OLIVER CARBONELL, José Luis  and  ABIZANDA SOLER, Pedro. Use of feeding tubes in patients with advanced dementia: systematic review. Rev Clin Med Fam [online]. 2013, vol.6, n.1, pp.37-42. ISSN 2386-8201.  https://dx.doi.org/10.4321/S1699-695X2013000100007.

Introduction: The onset of dysphagia is a sign of the final stage of dementia. Studies up to the year 2000 called into question the objectives which justify the insertion of a feeding tube, but this continues to be a frequent intervention in advanced dementias.  Objectives: To answer the following questions based on available evidence: Does feeding by PEG tubes in advanced dementia prevent aspiration? Does it prevent malnutrition? Does it increase survival rates? Are they treated palliatively? Methodology: Bibliographic research. Studies published 2000-2012. English and Spanish. Databases: Pubmed, Google Scholar, Cochrane. MeSH: Dementia, Enteral nutrition, Nutritional support, Endoscopic gastrostomy, Tube feeding, PEG, Enteral feeding, Ethics, Quality of life, Palliative care, Dysphagia and Making decisions. Results: 96 articles met criteria to be included in this study. 24 Spanish, 72 in international publications. Nasogastric and PEG tubes are not indicated in patients at risk of bronchoaspirations; neither do those indicated by ESPEN prevent them. The ESPEN guide does not consider the use of feeding tubes to be suitable in the final stage of dementia; weight loss is a consequence of the disease. Studies suggest factors which affect survival negatively. Mortality in the first 30 days after insertion of the tube is very high. Dementia is not  accepted as a terminal disease, causing ambivalence in decision taking at the end of life. Training in non-oncological palliative care is very limited, a fact which can increase the establishment of disproportionate treatments. Conclusions: Enteral feeding in advanced dementia continues to be a frequent intervention; there is no evidence which establishes that tube feeding prevents aspirations, or that an improvement in nutritional status is achieved, or that it prevents malnutrition or its consequences. Neither are higher survival rates achieved; there are even studies which suggest lower survival rates. These patients are not benefited by palliative care because severe  dementia has not traditionally been considered a terminal disease, despite the fact that many studies claim that a higher quality of life would be achieved in the final stage of the illness.

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