Most adequate elder care focuses on “quality of life.” But the phrase itself is somewhat elusive. In a few situations it is not necessary easy to determine if a certain course of conduct will improve one’s quality of life or make it worse. There are general principles that can be applied to better make choices on behalf of a senior loved one, but every decision is ultimately a personal one. What might be a welcome act or service for one person may be shunned by another. All of this is why we continue urge resident-centered care that is based upon specific understanding of an individual’s strengths, weakness, likes, and dislikes.
One area where these questions are often asks relates to use of feeding tubes. An editorial from My Elder Advocate recently touched on the concerns, providing an interesting perspective on the use of these measures among those caring for seniors. In short, the article explains how at first blush it may seem like use of feeding tubes is a critical life-saving step. However, the truth is that there are serious questions about whether these tubes serve any function. In fact, in some cases seniors may ultimately suffer serious injury or death as a result of their use.
According to some sources, in the worst performing homes as many at 35% of all residents with cognitive impairments (dementia, Alzheimer’s) are on feeding tubes. Those familiar with basic elder abuse facts understand that residents with these mental impairments are always far more likely to fall victim to elder neglect.
Of course in certain limited settings the use of feeding tubes may be essential. This includes situations where the senior has swallowing issues or to prevent aspiration pneumonia. However, as with many other treatments that are important in limited situations (i.e. antipsychotic medications), feeding tubes are often drastically over-used. The over-use is usually caused by the convenience factors–caregivers may decide to continue use because it makes their job easier, not because it is absolutely necessary for the resident.
The potential overuse of feeding tubes is not just a theoretical issue–the use of the devices comes with real risk of harm. For example, one study found that elderly individuals who are on a feeding tube at a hospital and then discharged into a skilled nursing facility are at a higher risk of developing pressure sores than those not on the feeding tube. In addition, there are many examples of caregivers who made mistakes with the insertion of the tube, errors which often prove fatal for the vulnerable elderly resident.
For these reasons, it is often more appropriate to engage in careful hand feeding of residents where at all possible. Besides minimizing a few risks, it is often far more comfortable to the senior to be fed that way as opposed to the obtrusive tube inserted into their body. However, as with so many caregiving issues, many facilities decide not to put in the time and staffing to actually allow hand feeding. There is a temptation to overuse the tubes simply for their convenience and cost-saving for the facility regardless of the resident’s best interest.
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