To tube feed or not?

[fuzzybabybunny]

My grand uncle is 96 and is in the hospital for pneumonia. His pneumonia is gone but now the doctors are very wary of him aspirating some food and getting pneumonia again. Unfortunately, he seems to choke on food easily and has difficulty swallowing. His veins can no longer take more IVs. As of now he's not getting enough nutrition, only doing about 300 calories a day when the doctors say he needs 1500. Most of the time he's asleep and is too tired to eat, plus has a lack of appetite.

So we need to decide whether to put him on a feeding tube or not. All the literature that I've read show feeding tubes as NOT effective:

From wiki:

"they do not prolong life, they do not decrease the risk of pneumonia, they do not improve wound healing, they do not help weight gain, and they do not help the patient regain any strength or functional ability such as walking or self-care."

The last reason is what we're shooting for. We are worried that without the proper nutrition he will just get weaker and weaker, so we want to just tube feed him with the right amount of nutrition now to have him regain his strength enough to eat more consistently on his own and without choking.

But the research disagrees with that plan. It also provides no explanation as to why tube feeding is so ineffective.

So.... now we are not sure what to do. One would think that dumping nutrition directly into the stomach would be a sure fire way to build up energy, but the research shows this not to be the case without providing an explanation.

 

[SociallyChallenged]

With what I've seen, you can either deny a feeding tube (likely a G-tube) and let your relative degrade... or you can give them a feeding tube and allow them to stagnate with no likely increase in function. The G-tube, IMO, can keep patients alive longer, but it does not come with an increased quality of life. If anything, it can reduce quality of life to a certain degree due to discomfort and avoidance of certain positions.

At 96, having suffered from pneumonia, he will likely continue to aspirate and acquire respiratory infections until one does him in. With a G-tube, he may live longer, but like I said - it will not likely result in an increase in function. He is 96, so you must be realistic about his potential outcome. This is a difficult decision, but the doctors are working with his best interests in mind longevity-wise. Aspiration pneumonia is recurrent and frequently fatal with time.

 

[Mr. Pedantic]

The problem with feeding tubes is that you can't just dump as much as you want down them - people still get sick and uncomfortable if you put in more than they can tolerate. And because the people who need them are usually quite systemically sick (don't know if this is the case in this situation) the patients have little appetite and are too ill to tolerate much anyway. If it' possible to get a central line in, then the parenteral feeding can supplement the NGT/NJT.

I haven't had a look at the research around feeding tubes, but if it's the only way to get energy in, then I would think that it would be worth it.