The G-Tube in Elderly Nursing Home Residents – Is it Abuse?

The G-tube in Elderly Nursing Home

Residents – Is it Abuse?

It can be a horrific sight.

Watching loved ones age and gradually become unable to care for themselves is difficult enough. But seeing them flat on their back, bound with restraints, with a feeding tube thrust down their nose—or worse, surgically implanted in their abdomen—is downright dreadful.

Nursing homes implant the gastric feeding tube, or G-tube in elderly patients with advanced cognitive impairments. These patients cannot otherwise feed themselves. At some homes, up to 35 percent of patients with serious cognitive impairments have the tube installed. Many of these patients are our parents and grandparents, and the closeness of those relationships makes the unpleasantness of the situation that much harder to bear.

Many family members fear that the implanting a G-tube in elderly residents is simply a way for caregivers or nursing home professionals to avoid having to deal with difficult patients. They wonder if it increases the possibility that their loved ones might suffer from elder neglect while in the hands of uncaring workers.

Why Use the G-tube?

Aside from cognitive difficulties, caregivers and nursing homes use the G-tube in elderly patients for a variety of reasons.

Some common reasons for g-tube use include the following:

• Patients refuse to eat
• Patients have difficulty swallowing
• Patients are at risk of aspiration pneumonia, which occurs when patients inhale food, saliva, liquids, or vomit

G-tube installation may be either permanent or temporary, depending on the patient and the reason for its use. In either case, there are risks to the procedure.

Risks of Using the G-tube in Elderly Patients

The procedure in which doctors permanently attach a feeding tube to a patient’s stomach through the abdominal wall is called “gastronomy.”

Risks associated with this procedure include the following:

• Infection or bleeding – The wound through which the tube enters the abdomen must be cleaned constantly or it my bleed and become infected. This is doubly problematical, because elderly patients often have compromised immune systems. It’s even worse if nutritional intake is interrupted
• Dislodgment – Patients with dementia or other cognitive impairments are at risk of thrashing around and dislodging the tube
• Tissue damage or wound leakage  – Even if the tube does not dislodge when patients thrash, they may suffer tissue damage or wound leakage due to tension placed on the tube
• Restraints –  Restraints may be necessary to prevent dislodging; this can be particularly upsetting to family members
• Digestion problems – Patients sometimes experience nausea, vomiting, or diarrhea.
• Risk of malnutrition – the feeding formula and water mix affect patients differently, so doctors usually start off by administering low doses

The Controversy over the G-tube in Elderly Patients

Although many nursing homes and elder care facilities argue that feeding tubes are a necessary, even life-saving device, the website My Elder Advocate raised concerns in a blog post in February 2013. It questioned whether the tubes should be used at all, especially give the risks of serious injury and death.

If you feel that your loved one might be underserved by (or even suffering neglect from) the caregiver or nursing home that installed a G-tube, many others share your fears. Consider seeking legal counsel to discuss your options.