Whether it’s your daily bowl of bran flakes or Thanksgiving dinner, food is important to us. We take comfort in our favorite foods and enjoy the companionship of friends and family when we dine. For people with dementia, food may still provide comfort, but the focus begins to shift toward providing adequate nutrition. As dementia progresses, it may leave sufferers unable to feed themselves. Because many nursing homes interpret the phrase “no artificial nutrition or hydration” in patients’ Advance Directives as “no tube, no food,” families are often forced to choose between inserting a feeding tube and withholding food. However, Dr. Joan Teno and her colleagues at Brown University argue that there is another option; careful hand feeding for comfort only.
A recent article in The New York Times explained that in comfort feeding nursing home staff or family caregivers feed small amounts of soft food to patients with advanced dementia. The staff or family member offers food until the patient is satisfied. The amount of food consumed may be only a few spoonfuls of ice cream or banana, but the quantity does not matter because the focus is on providing comfort not calories.
Dr. Teno believes that comfort feeding offers a humane approach to end-of-life care for people with advanced dementia. She points to studies showing that feeding tubes do not necessarily prolong the lives of patients with advanced dementia. In addition, feeding tubes do not prevent aspiration in people who cannot swallow, and they are uncomfortable, causing people to be restrained or sedated to keep them from pulling the tubes out. While comfort feeding may offer another option to a feeding tube, it cannot be used for people who are unable to swallow. In addition, comfort feeding also is time consuming and labor intensive.
To read more about comfort feeding in The New York Times, click here.