Careful hand feeding: a reasonable alternative to PEG tube placement in individuals with dementia

Individuals with dementia inevitably experience decreased oral intake when they are no longer able to recognize food, feed themselves independently, or experience swallowing difficulties. There is mounting evidence that routine insertion of a percutaneous endoscopic gastrostomy (PEG) does not significantly affect survival, nor does it reduce the risk of aspiration pneumonia and pressure ulcer formation. Although there is relatively little published on assisted oral feeding, its advantages include allowing the patient to enjoy the gratification of eating and socialization that accompanies mealtime, as well as avoiding restraint use that often accompanies PEG placement. Nurses can play a pivotal role in assessment of feeding difficulties, implementation of innovative mealtime programs, educating families about specific strategies to optimize oral intake, and participating in research to evaluate patient outcomes.