The placement of a feeding tube in older adults, while seemingly a straightforward intervention for nutritional support, presents complex ethical and medical considerations. A primary concern arises when the potential benefits of artificial nutrition and hydration are unlikely to outweigh the burdens imposed on the individual. This situation can occur when the individual is nearing the end of life due to a terminal illness or experiences severe, irreversible cognitive decline where feeding tubes may prolong suffering without improving quality of life. For example, a patient with advanced dementia who repeatedly pulls out the feeding tube may experience increased agitation and require physical restraints, leading to decreased well-being.
Historically, the use of feeding tubes was often viewed as an automatic response to nutritional deficits, reflecting a societal imperative to sustain life at all costs. However, accumulating evidence and evolving ethical perspectives highlight that such interventions do not consistently improve survival rates or quality of life in specific patient populations. In individuals with advanced dementia, feeding tubes have not been shown to prevent aspiration pneumonia, improve wound healing, or extend life expectancy. Instead, they may be associated with complications such as infections, skin breakdown, and fluid overload. It is crucial to consider the patient’s overall condition, prognosis, and previously expressed wishes when making decisions about artificial nutrition.
