II. Management: Enteral Feeding Tube use is NOT Recommended
- No support for Feeding Tube (e.g. PEG) use in the literature
- Does not improve functional status, nutritional markers or survival in Dementia patients
- Does not reduce the risk of Aspiration Pneumonia in Dementia patients
- Often requires restraints for Feeding Tube placement and maintenance
- Associated with adverse effects (pain, Cellulitis, Vomiting, Diarrhea, fluid imbalance)
- Conscientious hand feeding is preferred alternative
- Previously used for Nutrition in Advanced Dementia
- Aspiration Pneumonia prophylaxis (disproven)
- Malnutrition (disproven)
- Pressure Ulcer reduction (disproven)
- Improved survival and function (disproven)
III. Management: General measures to improve food intake
- See Dysphagia Diet for possible limitations
- Strong flavors should be used
- Serve foods either hot or cold (not tepid)
- Enhance flavor with spice, gravy, juice, cream
- Offer preferred foods without restriction
- Ice cream
- Miniature chocolate bars
- Consider liquid supplements (e.g. Ensure, Boost)
- Avoid near meal time (avoid within 2 hours of meal)
- Consider alternatives to commercial supplements
- Milkshakes
- Blended food (e.g. cereal in eggnog)
- Patient should have easy access to food
- Mealtime duration may need to be lengthened
- Place finger foods, candy bars, liquids at bedside
- Create No-fail Environment in Dementia
- Provide meals at midday at maximal cognitive function
- Reduce Agitation in patients
- Hold hands or gently touch
- Talk about pleasant topics or sing softly