Intended for healthcare professionals

Analysis And Comment Controversy

Tube feeding in advanced dementia: the metabolic perspective

BMJ 2006; 333 doi: (Published 07 December 2006) Cite this as: BMJ 2006;333:1214
  1. L John Hoffer, professor
  1. 1Faculty of Medicine, McGill University, Montreal, QC, Canada
  1. Correspondence to: L J Hoffer, Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote-Ste-Catherine Road, Montreal, QC, Canada H3T 1E2 l.hoffer{at}
  • Accepted 10 October 2006

Problems with the procedure do not fully explain its ineffectiveness

Questions about tube feeding in advanced dementia continue to bedevil doctors, surrogate decision makers, and administrators and stimulate research, topic reviews, and position papers.1 2 3 4 5 This article shows that the dilemma of whether or not to tube feed an incompetent, demented patient can always be clarified, and often resolved, by applying the principles of nutritional physiology. The concepts described in this article have not previously appeared in the literature dealing with the artificial feeding of incompetent patients.

Elderly demented patients often eat enough for their diminished energy requirements

Physiological homoeostasis or progressive starvation?

Reduced food intake and weight loss are normal features of advancing old age.6 7 Food intake by elderly people may also be pathologically curtailed by factors such as ill fitting dentures, functional disability, depression, isolation, and poverty. There is increasing evidence that non-demented, elderly malnourished people benefit from nutritional supplements.8 To my knowledge, no randomised clinical trials have been carried out in tube fed, severely demented patients,9 but observational data and the results of trials of tube feeding in other conditions have led to a consensus of expert opinion that tube feeding patients with advanced dementia neither prolongs their life nor improves its quality.1 3 4 5 9 10 11 12 Why would this be so?

Tube feeding shortens the life of some patients, and it is often inefficient at delivering food.4 5 9 10 12 13 But problems with the procedure do not fully explain its ineffectiveness. Severely demented patients usually fail to benefit …

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