When a person begins to eat less, lose weight and have difficulty swallowing, the issue of using tube feedings to optimize nutrition and safety often arises.
For their intended use, tube feedings can be a benefit. Their intended use is temporary and short term, when caregivers expect that a person with a reversible problem can recover and regain the ability to eat and drink normally.
But someone is approaching their final months or weeks of life, tube feedings are a burden. They can actually result in a poorer quality of life and even hasten death.
When a person begins to lose their swallow or gag reflex, food and water can go down “the wrong pipe.” Rather than going down the esophagus, the tube that leads to the stomach, they go down the bronchus, the tube that leads to the lungs. (Healthcare providers call this “aspiration.”) Choking and coughing ensues — an unpleasant and scary event for all concerned.
This is the point at which healthcare providers sometimes suggest tube feedings for “safety.” But, in fact, tube feedings may actually increase the risk of aspiration.
Let me explain.
If you go to an all-you-eat-eat buffet, you happily pig out to enjoy the diversity of tasty food and get your money’s worth. But there will be a moment when your stomach sends the message, “Don’t send anything else down here! There is no room, so I will send it back up!” Because you are in control of your response, you naturally choose to stop eating (or suffer the consequences).
When a person has a tube in their stomach that is delivering liquid food, they do not have the ability to stop the flow as their stomach fills up. Unchecked, the liquid feeding can fill the stomach and then rise up into the esophagus. When the esophagus becomes too full, the feeding can then spill into the bronchial tubes and go down into the lungs. This can easily lead to aspiration pneumonia, which causes difficulty breathing and shortness of breath — the very problem the tube feeding was supposed to prevent!
And, unfortunately, that’s not all. Other complications of tube feedings include pain, leakage and infection at the site where the tube enters the body. Diarrhea and gastric reflux can also occur.
Studies on tube feedings used near the end of life reveal that they:
- Will not help the person regain strength
- Do not prolong life
- Do not promote wound healing
- Do not prevent aspiration pneumonia
- Are associated with an increased risk of death
Therefore, they are not at all consistent with providing the best or most comfortable care.
The body is wise. As it begins to shut down as the end of life approaches, we need only watch and respond appropriately to the messages it gives us. Difficulty chewing and swallowing toast? Try something more moist like oatmeal or applesauce. Too thick? Try milkshakes or soup. Let your loved one be your guide. Accept and honor the bodies changes and offer only what they tolerate and enjoy.
Say “no” to tube feedings near the end of life.
Tani Bahti, RN, CT, CHPN, offers practical guidance to demystify the dying process. A RN since 1976, Tani has been working to empower families and healthcare professionals to enable the best end-of-life experience possible through education and the development of helpful tools and resources. The current owner of Pathways, Tani is also the author of “Dying to Know, Straight Talk About Death and Dying,” a book that SevenPonds considers one of the most helpful books on the subject available today. Founder Suzette Sherman says, “This is the book I will have at the bedside of my dying parents some day, hopefully, a very long time from now.”