Old age homes in the UK could be making life miserable for the elderly by insisting on artificial feeding. Those unwilling to opt for tube-feeding are simply denied admission, it turns out.
A report from the Royal College of Physicians states that artificial feeding involving tubes inserted into a person's stomach is being used too frequently, often because staff shortages mean there is not enough time for conventional feeding.
The report, brought out by a working group of the Royal College, focuses on patients approaching the end of life and has been issued in response to concerns over artificial nutrition and hydration, in practice widely in the country.
The report concludes that many patients, such as Alzheimer's sufferers, are receiving the treatment because it is an "easy option."
The technique risks infections and also deprives patients of the pleasure of taste, and social interaction that come with normal eating. Besides there is no evidence that tube feeding prolongs life, it is pointed out.
The college issued guidelines urging doctors and nurses to view artificial feeding as a last resort. A recent survey showed that 39,000 people were artificially fed outside hospital, either at home or in residential care, over the course of a year. Two thirds were fed that way because of the difficulty they had in swallowing.
With time and care, elderly people with swallowing difficulties can be helped to eat and drink normally, says the report and warned against the percutaneous endoscpic gastrostomy (PEG), describing it as an invasive procedure with risk. The procedure involves inserting tubes through the abdomen wall into the stomach.
Of all artificial feeding techniques, PEG is the most commonly used. Among data collected for the report was one audit of 719 PEG procedures, published in 2004, which found 19 per cent were "futile" and did nothing to prolong life.
The report found that many care homes across the country are making it a condition of residence that people, often in the advanced stages of dementia, have a tube fitted into their abdomen. Such shouldn't be the case at all, the Royal College group stressed.
While a nasal tube is safer than a device fitted in the abdomen, a so-called PEG, the best option for patients is normal feeding wherever possible. "'Nil by mouth' should be a last resort," says the report.
It also calls for agreement between the patient, relatives and healthcare professionals about the aims of artificial feeding. Such decisions should never be based on the convenience of staff or carers, the repot said. More important, all trusts and care homes should ensure there are enough staff to help those with difficulties take longer to eat, especially at meal times.
"People in the later stages of dementia have complex end-of-life needs and it is vital that the use of artificial nutrition or hydration not be used in place of good quality care tailored to their specific needs," said Neil Hunt, chief executive of the Alzheimer's Society. "The quality of life should be considered a priority over length of life in the later stages of dementia," he added.
Dr John Saunders, of the RCP Committee for Ethical Issues in Medicine, said the practice was most questionable when patients such as those with dementia could not give their consent.The guidance was issued against a background of 39 per cent of hospital in-patients in the UK being malnourished.
"The patient's family often benefits more from PEG than the patient, particularly in terms of overall management and time needed," said the authors. "However, doctors have a duty to put the patient first."