Thought provoking article from the New York Times related to a decision that’s often faced by caregivers to advanced stage dementia patients. Alzheimer’s disease typically starts to destroy the part of the brain that controls eating as the patient is nearing the end of life. Caregiver’s or family are then presented with a choice to have a gastric feeding tube inserted or to withhold nourishment. Clearly neither is a pleasant option.
The article highlights a relatively new option in palliative care, referred to as “comfort feeding only”.
“We believe careful hand-feeding is a much more humane way of taking care of these people, and preserves the patient’s dignity,” said an author of the paper, Dr. Joan Teno, a professor of community health at Brown University’s medical school. “They can still have that human interaction and intimate contact that comes with being fed.
“Just imagine someone interacting with the patient, talking to them, cueing them into eating,” Dr. Teno said, “as opposed to someone walking to the bedside and pouring a bottle of Ensure down the feeding tube.”
The theory is a simple one. The patient is fed as much or as little as he/she wants and feeding is stopped if the patient starts choking or becomes agitated. It’s a time consuming process and requires a lot of patience (which is why a lot of nursing homes do not offer hand-feeding as an option), but it could be the alternative a family is looking to discover. One gentleman interviewed for the article offers his perspective on handing-feeding his wife of 63 years for the past 4 years that she’s been in a nursing home:
Each feeding takes 45 minutes to an hour, said Mr. Geffner, 86.
“Some days are better than others,” he said. “The food is puréed, and she doesn’t eat a full meal. But I always give her at least half a banana every day, and strawberries in season.”
“The bottom line is she doesn’t go hungry,” he said. “She looks good.”
That just feels so much better to me than the traditional alternatives.