Editing Dementia (section)

===Eating difficulties===
Persons with dementia may have difficulty eating. Whenever it is available as an option, the recommended response to eating problems is having a caretaker [[assisted feeding|assist them]].<ref name="AGSantipsychotic"/> For people who do not have dementia, a secondary option when they cannot swallow effectively would be to consider [[Percutaneous endoscopic gastrostomy|gastrostomy]] [[feeding tube]] placement as a way to give nutrition. However, for people with dementia, assistance with oral feeding is at least as good as tube feeding in bringing comfort and maintaining functional status while lowering risk of [[aspiration pneumonia]] and death<ref name="AGSantipsychotic" /><ref>{{Citation |author1=AMDA – The Society for Post-Acute and Long-Term Care Medicine |title=Five Things Physicians and Patients Should Question |date=February 2014 |work=[[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url=http://www.choosingwisely.org/doctor-patient-lists/amda/ |access-date=February 10, 2013 |archive-url=https://web.archive.org/web/20140913011101/http://www.choosingwisely.org/doctor-patient-lists/amda/ |archive-date=September 13, 2014 |url-status=live |publisher=AMDA – The Society for Post-Acute and Long-Term Care Medicine |author1-link=AMDA – The Society for Post-Acute and Long-Term Care Medicine}}</ref> It can be tried if the reasons for the person’s problems with eating, drinking or swallowing are treatable and it’s expected that they will be able to start eating and drinking normally afterwards.<ref>{{Cite web |title=Patient decision aid on enteral (tube) feeding for people living with severe dementia. |url=https://www.nice.org.uk/guidance/ng97/resources/enteral-tube-feeding-for-people-living-with-severe-dementia-patient-decision-aid-pdf-4852697007 |access-date=16 April 2025 |website=National Institute for Health and Care Excellence (NICE)}}</ref> Tube-feeding is associated with agitation, increased use of physical and chemical restraints and worsening [[pressure ulcer]]s. Tube feedings may cause fluid overload, diarrhea, abdominal pain, local complications, less human interaction and may increase the risk of aspiration.<ref>{{Citation |author1 = AMDA – The Society for Post-Acute and Long-Term Care Medicine |author1-link = AMDA – The Society for Post-Acute and Long-Term Care Medicine |date = February 2014 |title = Five Things Physicians and Patients Should Question |publisher = AMDA – The Society for Post-Acute and Long-Term Care Medicine |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/amda/ |access-date = February 10, 2013 |url-status = live |archive-url = https://web.archive.org/web/20140913011101/http://www.choosingwisely.org/doctor-patient-lists/amda/ |archive-date = September 13, 2014 }}, which cites:
* {{cite journal | vauthors = Teno JM, Gozalo PL, Mitchell SL, Kuo S, Rhodes RL, Bynum JP, Mor V | title = Does feeding tube insertion and its timing improve survival? | journal = Journal of the American Geriatrics Society | volume = 60 | issue = 10 | pages = 1918–1921 | date = October 2012 | pmid = 23002947 | pmc = 3470758 | doi = 10.1111/j.1532-5415.2012.04148.x }}
* {{cite journal | vauthors = Palecek EJ, Teno JM, Casarett DJ, Hanson LC, Rhodes RL, Mitchell SL | title = Comfort feeding only: a proposal to bring clarity to decision-making regarding difficulty with eating for persons with advanced dementia | journal = Journal of the American Geriatrics Society | volume = 58 | issue = 3 | pages = 580–584 | date = March 2010 | pmid = 20398123 | pmc = 2872797 | doi = 10.1111/j.1532-5415.2010.02740.x }}
* {{cite journal | vauthors = Gillick MR, Volandes AE | title = The standard of caring: why do we still use feeding tubes in patients with advanced dementia? | journal = Journal of the American Medical Directors Association | volume = 9 | issue = 5 | pages = 364–367 | date = June 2008 | pmid = 18519120 | doi = 10.1016/j.jamda.2008.03.011 }}</ref><ref>{{cite journal | vauthors = Mitchell SL, Kiely DK, Lipsitz LA | title = The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment | journal = Archives of Internal Medicine | volume = 157 | issue = 3 | pages = 327–332 | date = February 1997 | pmid = 9040301 | doi = 10.1001/archinte.1997.00440240091014 }}</ref>

Benefits in those with advanced dementia has not been shown.<ref>{{cite journal | vauthors = Sampson EL, Candy B, Jones L | title = Enteral tube feeding for older people with advanced dementia | journal = The Cochrane Database of Systematic Reviews | issue = 2 | page = CD007209 | date = April 2009 | volume = 2009 | pmid = 19370678 | doi = 10.1002/14651858.CD007209.pub2 | pmc = 7182132 }}</ref> The risks of using tube feeding include agitation, rejection by the person (pulling out the tube, or otherwise physical or chemical immobilization to prevent them from doing this), or developing pressure ulcers.<ref name="AGSantipsychotic"/> The procedure is directly related to a 1% fatality rate<ref>{{cite journal | vauthors = Lockett MA, Templeton ML, Byrne TK, Norcross ED | title = Percutaneous endoscopic gastrostomy complications in a tertiary-care center | journal = The American Surgeon | volume = 68 | issue = 2 | pages = 117–120 | date = February 2002 | doi = 10.1177/000313480206800202 | pmid = 11842953 | s2cid = 43796062 }}</ref> with a 3% major complication rate.<ref>{{cite journal | vauthors = Finocchiaro C, Galletti R, Rovera G, Ferrari A, Todros L, Vuolo A, Balzola F | title = Percutaneous endoscopic gastrostomy: a long-term follow-up | journal = Nutrition | volume = 13 | issue = 6 | pages = 520–523 | date = June 1997 | pmid = 9263232 | doi = 10.1016/S0899-9007(97)00030-0 }}</ref> The percentage of people at end of life with dementia using feeding tubes in the US has dropped from 12% in 2000 to 6% as of 2014.<ref>{{cite journal | vauthors = Mitchell SL, Mor V, Gozalo PL, Servadio JL, Teno JM | title = Tube Feeding in US Nursing Home Residents With Advanced Dementia, 2000–2014 | journal = JAMA | volume = 316 | issue = 7 | pages = 769–770 | date = August 2016 | pmid = 27533163 | pmc = 4991625 | doi = 10.1001/jama.2016.9374 | url = http://jama.jamanetwork.com/data/journals/jama/935644/jld160020.pdf | url-status = live | archive-url = https://web.archive.org/web/20170921235656/http://jama.jamanetwork.com/data/journals/jama/935644/jld160020.pdf | archive-date = September 21, 2017 }}</ref><ref name="NYT20160816">{{Cite news | url = https://www.nytimes.com/2016/08/30/health/tube-feeding-dementia-patients.html | title = The Decline of Tube Feeding for Dementia Patients | date = August 29, 2016 | work = [[The New York Times]] | vauthors = Span P | access-date = August 31, 2016 | url-status = live | archive-url = https://web.archive.org/web/20160903051930/http://www.nytimes.com/2016/08/30/health/tube-feeding-dementia-patients.html | archive-date = September 3, 2016 }}</ref>

The immediate and long-term effects of modifying the thickness of fluids for swallowing difficulties in people with dementia are not well known.<ref name="Flynn_2018">{{cite journal | vauthors = Flynn E, Smith CH, Walsh CD, Walshe M | title = Modifying the consistency of food and fluids for swallowing difficulties in dementia | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 9 | page = CD011077 | date = September 2018 | pmid = 30251253 | pmc = 6513397 | doi = 10.1002/14651858.cd011077.pub2 }}</ref> While thickening fluids may have an immediate positive effect on swallowing and improving oral intake, the long-term impact on the health of the person with dementia should also be considered.<ref name="Flynn_2018" />