Enteral tube feeding in people with advanced dementia

Dementia is a chronic, progressive, and irreversible disease affecting cognition, behaviour, and function. Alzheimer’s disease, vascular dementia, and mixed dementia (Alzheimer’s and vascular pathology) constitute most cases. Worldwide, more than 57 million people are living with dementia, and this number is expected to increase to more than 152 million in 2050.1 The regions projected to have the highest percentage increases in dementia cases are north Africa, the Middle East, and eastern sub-Saharan Africa.1 A recent meta-analysis found that mean survival time from onset of Alzheimer’s disease was 7.6 years, and this was shorter for people with non-Alzheimer’s dementia (6.5 years for vascular dementia and 6.8 years for dementia with Lewy bodies).2 While there is heterogeneity in disease progression, people dying from dementia typically experience a prolonged advanced stage.34 Many people with advanced dementia experience burdensome symptoms and poor quality of life, and many of their family caregivers experience substantial caregiver strain, including physical, psychological, emotional, behavioural, and financial stress.456

Difficulty eating is a common complication of advanced dementia and can manifest as dysphagia, the inability to feed oneself, and the refusal to eat.47 Many professional society guidelines advise against recommending enteral feeding tubes in patients with advanced dementia and instead suggest oral feeding (see box 1).89 …