We agree that in the short term, a person with advanced dementia who is no longer able to swallow is likely to have life prolonged by tube feeding. While it is possible that the subjects receiving tube feeding in our study would have died sooner without it, our data do not permit us to confirm or refute this hypothesis. The important point for physicians and family decision makers is that the mortality rate was high (50% at 6 months) and equal in those treated with and without artificial nutrition and hydration. This finding has been confirmed in multiple other studies.1- 5 Tube feeding does not reverse or stabilize the progression of the underlying dementing illness, nor does it prevent repeated aspiration of oronasopharyngeal secretions, as well as other common infections associated with immobility and confinement to bed or chair. Once a patient reaches this stage of illness, life expectancy is limited independent of the use of tube feeding.
Meier DE, Morrison RS. Dementia, Gastrostomy Tubes, and Mortality—Reply. Arch Intern Med. 2001;161(19):2385-2386. doi: