Decisions about Enteral Tube Feeding among the Elderly

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Abstract
To determine choices about enteral tube feeding and factors associated with deciding to accept or forego this intervention in a group of ambulatory non-demented older individuals. Descriptive survey. Thirty four volunteers from a senior adult day center and 34 volunteers from the residential care section of a multilevel long-term care institution, mean age 77.8. Structured interview using a hypothetical clinical vignette in simplified language, story-book format depicting an irreversibly and severely impaired state of health. Choice of whether to accept or forego enteral tube feeding based on the clinical vignette. Thirty four (50%) decided to accept and 34 (50%) chose to forego enteral tube feeding in the situation presented in the vignette. No demographic, cognitive, or affective factors were associated with the decision. Presentation of the vignette and associated questions were not anxiety-provoking or upsetting to the vast majority of participants. A hypothetical clinical vignette depicting a state of severely impaired health resulted in 34 (50%) of 68 ambulatory non-demented older individuals deciding to accept enteral tube feeding. No factors we examined were strongly associated with the decision. The vignette and discussion were not anxiety-provoking when presented in the format used in this study. Advance-directive discussions about enteral tube feeding and other health care decisions, using understandable hypothetical clinical vignettes that describe risks and benefits that might influence decisions, should be encouraged in the practice of geriatric medicine.

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