#Futility: Do you place feeding tubes in your practice for older adults with advanced dementia? @SIRRFS @SIRspecialists @BSIR_News @AmCollSurgeons

Discussion below

Guideline recommendation: Feeding tubes are not recommended for older adults with advanced dementia. Careful hand feeding should be offered as it is at least as good as tube feeding for the outcomes of death, aspiration pneumonia, functional status, and comfort. (1/n)

Efforts to enhance oral feeding by altering the environment and creating individual-centered approaches to feeding should be part of usual care for older adults with advanced dementia. (2/n)

Tube feeding is a medical therapy that an individual surrogate decision-maker can decline or accept in accordance with advance directives, previously stated wishes, or what it is thought the individual would want. (3/n)

A Kaiser IR group recently partnered with palliative care to implement an institutional policy of not placing feeding tubes in patients with severe dementia in accordance with these guidelines. (4/n)

Why this matters? Potentially inappropriate/futile interventions expose patients to risks and costs without a meaningful chance of benefit. It also takes time and resources that could be devoted to developing other areas of practice and can lead to burnout among clinicians. (5/5)