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Forced feeding of the geriatric patient

Larry H. Bernstein, MD, FCAP, Curator

LPBI

 

The New York Times of 11/24/2015 carried an Op-Ed “Stop Force-Feeding the Elderly”. The article is reminiscent of the experience of my Uncle Herman, in a nursing home at age 98.  He was not really incapable of taking care of himself, but he had lived in the same place the his recently deceased wife had been.  A nurse tried to place a feeding tube and he refused, and when she said he needed it, he smacked her down.  That was a year before he died.

In important issue that is not stated is that nutritional care is important in nursing homes, and there is very poor assessment of nutritional status of these patients.  It was many years ago that I was unable to provide the support for testing of transthyretin testing at a nursing home in New Haven, mainly because it was not in contract with Bridgeport Hospital.  However, I knew someone in another state who was formerly a representative of a major pharmaceutical company and she took a position at a nursing home.  She was thoroughly familiar with my publications on transthyretin and cachexia.  It is not only an issue with hospitalized patients who are hypermetabolic, mainly posttraumatic, postoperative, or burn patients, but is also seen in the geriatric patient unable to carry out the activities of daily living.

The NY Times article informs us that there is excessive forced feeding in nursing homes because they may have poorly prepared nursing and ancillary staff who are also not well paid.  It points out that tube feeding is often given to patients with dementia who should not even be offered such treatment.

The experience described is a viscous nutritional formula pumped into a feeding tube inserted into the stomach via nasopharyngeal passage.  The well trained pathologist is quite familiar with the epithelial erosion that occurs from tube placement into the esophagus.

The author, Haider Javed Warraich, describes an experience  as follows: “The nearest I ever came to experiencing what I might feel like was last winter when I came down with the sniffles and went to the clinic for a nasopharyngeal swab to rule out the flu. The swab inserted in my nose was perhaps a tenth the size of the smallest feeding tube, and I felt as if it were tearing all the way into my brain stem.”

Furthermore, even if food supplementation is required, a protein shake can be given orally, and if the oral route is not accessible, a small port of entry can be made for temporary use directly to the stomach.

The writer describes the incident of a demented, glassy eyed patient who stared at the ceiling. He had a chest tube draining fluid because of pneumonia.  The family requested that a feeding tube be placed.  The intern started the placement with care.  The patient spoke the first words he expressed in months:
“Kill me”.  This became a screaming : “killmekillme…”.

 

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