In their cohort study of hospitalized patients with advanced dementia, Meier and colleagues1 found that patients who did not receive gastrostomy tubes had a median survival similar to that of patients who did receive tubes. However, these data cannot support the authors' conclusion that tube feeding "has no measurable influence on survival."
Some patients with end-stage dementia simply stop eating and drinking altogether; obviously, they will die within a week or two without medically administered nutrition and hydration. Among the patients in this study, it is possible that tubes were placed primarily in a subgroup of patients whose oral intake had become insufficient to sustain life, thus prolonging their survival to the observed median of about 6 months. In contrast, it is likely that tubes were not placed in the subgroup of patients who retained some capacity to eat; those patients also survived a median of roughly 6 months. In other words, the ability to eat could be a confounding factor that explains the similar survival in the 2 subgroups. The authors1 note in Table 2 that 22% of the subjects had "poor oral intake before hospital admission," but this characteristic would not necessarily reflect the patient's capacity to eat during the weeks after the index hospitalization for acute illness.