Nutritional Support for Dying or Severely Demented Patients
Measures that may increase oral intake include
Certain antidepressants, megestrol acetate, and dronabinol may stimulate appetite. Metoclopramide enhances gastric emptying, but it may take 1 to 2 weeks to reach peak effectiveness.
Advanced dementia eventually leads to inability to eat; sometimes affected patients are given tube feedings. However, there is no convincing evidence that tube feedings prolong life, provide comfort, improve function, or prevent complications (eg, aspiration, pressure ulcers).
Tube feedings and parenteral nutrition cause discomfort and are usually not indicated for patients who are dying or too demented to eat. Forgoing nutritional support may be difficult for family members to accept, but they should understand that patients are usually more comfortable eating and drinking as they choose. Sips of water and easy-to-swallow foods may be useful. Supportive care, including good oral hygiene (eg, brushing the teeth, moistening the oral cavity with swabs and ice chips as needed, applying lip salve), can physically and psychologically comfort the patients and the family members who provide the care. Patients should be encouraged to enter a hospice program, which can provide the needed support.
Counseling may help family members who are dealing with anxieties about whether to use invasive nutritional support (see Total Parenteral Nutrition and Enteral Tube Nutrition). Palliative care physicians are specifically trained to comfort patients and family members; early consultation with a palliative care team is encouraged.
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