Friday, December 8, 2006
BMJ has an opinion piece about tube feeding in advanced dementia which addresses the issue from a novel perspective. The author, a physician, essentially makes the following argument.... Weight loss in advanced dementia is normal and OK. The muscle wasting associated with progressive physical disability causes a concomitant slowing of the metabolic rate and many patients will lose a lot of weight but eventually settle out, taking in very little nutrition, but enough to supply their meager energy requirements. This is ok, and tube feeding then becomes a non-issue--it's just not indicated. The author provides little evidence to support this, and I can't say that the article will likely change the debate much, particularly as proponents of tube feeding can provide a lot of evidence that weight loss in dementia is associated with increased mortality--that is the only thing in this entire debate about which we can be sure.