Feeding Tubes for Older Adults: Is It the Right Decision?
Key takeaways:
A PEG tube is a type of permanent feeding tube. It can be helpful for someone who cannot swallow safely, or take in enough calories on their own.
In older adults, a feeding tube may be recommended for someone who is ill but expected to recover. Examples include someone who has had a stroke, has cancer of the throat or esophagus, or is critically ill in the ICU.
A feeding tube is less beneficial in situations where life expectancy is limited. It may not improve quality of life or lifespan in some situations. This is especially true for someone with advanced dementia.
We all need nourishment to survive. Unfortunately, some health conditions can prevent people from getting needed nutrition without help. In these cases, a permanent feeding tube, also known as a percutaneous endoscopic gastrostomy (PEG) tube, can be a true lifeline.
But what about when a feeding tube is recommended for someone older, or with a limited life expectancy? If you ever have to decide on a feeding tube for yourself or a loved one, it will be helpful to know when it is most (or least) beneficial.
What is a PEG (feeding) tube?
A PEG tube is a feeding tube that goes into the stomach through the skin of the abdomen. It can be placed easily in a quick surgical procedure, while the person undergoing surgery is sedated.
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PEG tubes provide a way to get nutrition directly into the stomach, bypassing the mouth and esophagus. They can be used for months or longer, but do eventually need to be replaced.
PEG tubes are also reversible, and can be removed if a person regains the ability to eat on their own. Once they are removed, the open hole in the abdomen will start to close up within days.
When is a PEG tube feeding recommended for older adults?
A PEG tube is recommended when a person is unable to safely swallow on their own. It is also recommended when a person cannot eat or drink enough to meet their daily calorie needs. Many health conditions can cause trouble with swallowing or weight loss. In older adults, some conditions are more likely to require decisions about feeding tubes.
Neurologic conditions
The simple act of swallowing requires over 30 nerves and muscles. Any condition that damages these nerves or muscles can affect swallowing. In older adults, neurologic conditions which often affect swallowing include:
Stroke
Parkinson’s disease
Dementia
Amyotrophic lateral sclerosis (ALS)
Multiple sclerosis
Cancer
Cancer in the head, neck, and esophagus leads to malnutrition in up to 40% of cases. In these cases, weight loss and malnutrition can be due to the location of the tumor itself, or the treatments directed against the cancer. For example, surgery and radiation therapy may cause damage or scarring of the tissues of the throat and esophagus.
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Critical illness
People hospitalized in the ICU are often too ill to take in adequate nutrition on their own. Initially, a person may be given nutrition through an IV (intravenous) catheter or a nasogastric tube. Nasogastric tubes are inserted through the nose and down into the stomach. They’re more painful and have more complications than PEG tubes. If a person remains ill for an extended period of time — if they are in a coma or on a mechanical ventilator — a PEG tube is often recommended.
What are the potential benefits of a feeding tube?
As mentioned above, a feeding tube allows someone to get nutrition when they cannot take in enough to satisfy their body’s needs. When needed for an extended time, a PEG tube is a more comfortable option, too. Getting nutrition through a PEG tube can allow time for treatment and healing so that a person can return to eating on their own. It can also prevent or reduce weight loss that could otherwise weaken a person and delay recovery. For people with a permanent condition, a PEG tube can be life-saving.
PEG tube complications
Despite the potential benefits, feeding tubes do come with risks and drawbacks. Some of the more common complications with a PEG tube include:
Skin irritation
Scarring
Bleeding
Infection
Dislodged tube
Tube blockage
When is a PEG tube not recommended?
In general, a PEG tube should only be used for a long term: over 30 days. But not every person who needs long-term nutrition will benefit from a PEG tube. There are some cases where a PEG tube is not recommended.
Advanced dementia
For people with advanced dementia, research suggests that feeding tubes do not have benefits. Specifically, there is no improvement in life expectancy, quality of life, or nutritional status. And they can actually cause harm. A feeding tube can increase agitation and need for restraint, worsening quality of life for someone with dementia. For these reasons, the American Geriatrics Society recommends against feeding tubes for people with dementia.
Advance care plans
When possible, a person should be supported in making their own decision about a feeding tube. But often, these decisions fall to relatives if the person is too sick to make their own choice. A living will can help communicate your wishes about when you would (or would not) want a feeding tube. Creating this document before a crisis ensures that your care will reflect your personal preferences and beliefs. You can also consider designating a healthcare proxy who knows your wishes, and can make decisions for you if you are unable to do so.
End of life
When someone is nearing death, their loved ones may worry that they will suffer without a feeding tube. But when a person is getting very close to death, the body can no longer absorb nutrition, even if given through a feeding tube. In these cases, a feeding tube may cause more pain and inconvenience than comfort. In these cases, it can be very reasonable to decline a feeding tube, or stop giving nutrition through a feeding tube.
Getting hospice care during this time can help to prevent pain and suffering related to the dying process. If you ever need to find a hospice agency, the National Partnership for Healthcare and Hospice Innovation has a toll-free hotline to help: (844) GET-NPHI.
The bottom line
Choosing whether to get a feeding tube is a complicated decision. If you’re trying to make this decision for a family member or loved one, it can be even harder. This is especially true if you don’t know your loved one’s specific wishes. It is important to know how long the feeding tube will be needed, and whether recovery is possible. The likelihood of having a good quality of life in the future is also an important consideration. If you are ever facing this decision, you are not alone. Healthcare professionals can discuss with you the potential risks and benefits of a feeding tube.
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References
Au, C., et al. (2020). Loose PEG tube leading to peristomal leakage and peritonitis, a case report. Journal of Education & Teaching in Emergency Medicine.
Daniel, K., et al. (2014). American Geriatrics Society feeding tubes in advanced dementia position statement. Journal of the American Geriatrics Society.
Doley, J. (2022). Enteral nutrition overview. Nutrients.
Motta, A. P. G., et al. (2021). Nasogastric/nasoenteric tube-related adverse events: An integrative review. Revista Latino-Americana de Enfermagem.
National Institute on Aging. (2022). Choosing a health care proxy.
Panara, K., et al. (2023). Physiology, swallowing. StatPearls.
Rahnemai-Azar, A. A., et al. (2014). Percutaneous endoscopic gastrostomy: Indications, technique, complications and management. World Journal of Gastroenterology.
Shah, R., et al. (2023). Gastrostomy tube replacement. StatPearls.
Vudayagiri, L., et al. (2023). Percutaneous endoscopic gastrostomy tube. StatPearls.
