Nutrition and Cognition in Dementia Care: Feeding Difficulty, Weight Loss and Decisions Near the End of Life
DOI:
https://doi.org/10.5281/zenodo.22302418Keywords:
Dementia, Feeding difficulty, Enteral tube feeding, Assisted oral feeding, End-of-life careAbstract
Guidance across several countries advises against enteral tube feeding in advanced dementia, and the position is well founded.
What is less often stated is the shape of the evidence behind it. Two Cochrane reviews, the first searching to 2008 and the second
to April 2021, each set out to find randomised trials and each found none. The first identified seven controlled observational
studies, six of which assessed mortality, and reported no evidence of increased survival, no study examining quality of life, and no
evidence of benefit for nutritional status or pressure ulcers. The second found no evidence that tube feeding improves survival or
quality of life, reduces pain or mortality, decreases behavioural and psychological symptoms, improves nourishment, or improves
family and carer outcomes. The complication is that observational comparisons in this setting cannot separate the effect of the
tube from the reason it was placed, so absence of demonstrated benefit and demonstrated absence of benefit are not the same
finding. The recommendation stands on other grounds, and stating them accurately matters to the families who receive it.
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