The clinical case against tube feeding in palliative care of the elderly

The terminal stages of many neurological illnesses occurring in the elderly produce feeding and swallowing problems. These difficulties lead to ethical, religious, philosophical, and medico-legal conflicts when decisions about starting or stopping tube feedings are considered. We present the case against all forms of tube feeding in a particular subset of elderly palliative patients. These are individuals who are in the end-stage of a progressive neurological disease who are noncommunicative, and spend all or most of their time in a recumbent position. We discuss the physiological phenomena existing in these patients that make the probability of aspiration pneumonia as great or possibly greater than with careful spoon feeding. If tube feeding results in the outcome that it is thought to prevent (ie, aspiration pneumonia) then decisions regarding nutritional support in these patients become clinically clearer.