Insufficient evidence for benefit of enteral tube feeding for older people with advanced dementia

Clinical question: 
How effective is enteral tube feeding for older people with advanced dementia?
Bottom line: 
Despite the large number of patients receiving this intervention, there is insufficient evidence for the effectiveness of enteral tube feeding for older people with advanced dementia in terms of survival, quality of life, nutrition and pressure ulcers, function and behavioural or psychiatric symptoms of dementia. Data are lacking on the adverse effects of this intervention.
Caveat: 
None of the studies reported comparability on a range of key characteristics between the intervention group and the comparison group. All studies were further limited in the range of their evaluation of enteral tube feeding outcomes. None of the studies examined quality of life. Enteral tube feeding may increase the risk of developing pneumonia due to inhaling small quantities of the feed, and may also increase the risk of death.
Context: 
The use of enteral tube feeding for patients with advanced dementia who have poor nutritional intake is common. In one US survey, 34% of 186,835 nursing home residents with advanced cognitive impairment were tube fed. Two methods of enteral tube feeding are commonly used: the administration of food and fluids via a nasogastric tube or via a percutaneous endoscopic gastrostomy (PEG). Potential benefits or harms of this practice are unclear.
Review CD#: 
CD007209
PEARLS No: 
190
Date: 
August, 2009
Authored by: 
Brian R McAvoy