Online Program

319083
Tube-feeding older adults with advanced dementia: Considerations from the Social Ecological Model


Sunday, November 1, 2015

Joy Douglas, MS, RDN, CSG, LD, Department of Health Science, University of Alabama, Tuscaloosa, AL
Lori Turner, PhD, RD, Department of Health Science, The University of Alabama, Tuscaloosa, AL
Background: Alzheimer’s disease is the 6th leading cause of death in the US and the most common form of dementia, afflicting 5.2 million Americans in 2014.  Alzheimer’s and other forms of advanced dementia often yield severe weight loss with feeding tubes as the intervention. However, this practice is ineffective and causes a myriad of problems. The purpose of this review is to examine the use of feeding tubes in elderly patients with dementia from a social ecological perspective.

Methods:  A systematic literature review was conducted. Articles were included if they addressed the use of feeding tubes in patients with dementia and pertained to the levels of the Social Ecological Model (SEM).

Results:  At the individual level, feeding tubes often cause physical discomfort, medical complications, increased emergency room admissions, social exclusion, depression and/or anxiety.  Family members experienced additional unneeded distress as they lacked information to make informed decisions. Healthcare professionals lack knowledge of evidence-based guidelines.  At the organizational level, corporate culture influences feeding tube rates; Medicaid patients are most likely to receive tube feedings. Regarding public policy, reimbursement structures encourage the use of feeding tubes; facilities are reimbursed at higher rates for patients with tube feedings.

Conclusions: The use of feeding tubes in patients with advanced dementia is a serious and complex issue, warranting approaches that target each level within the Social Ecological Model.  Educating individuals and family members, as well as providing the healthcare team with current evidence-based guidelines are recommended.  Organizational norms and healthcare policies need to be revisited.

Learning Areas:

Administer health education strategies, interventions and programs
Chronic disease management and prevention
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe how the use of feeding tubes in adults with advanced dementia impacts the individual and their family members and caregivers. Discuss how organizational structure and health policy impact the use of feeding tubes in patients with advanced dementia. List strategies to encourage appropriate use of feeding tubes at each level of the Social Ecological Model.

Keyword(s): Dementia, Nutrition

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked as a Registered Dietitian with this population since 2007 in the acute and long-term care settings. I have first-hand knowledge on the subject due to my clinical work. Furthermore, I am currently in a Health Education/Health Promotion PhD program, where my research focus is nutrition status among older adults with dementia.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.