Is a Nasogastric Tube Necessary for My Elderly Grandmother's Condition?

Q: Is a Nasogastric Tube Necessary for My Elderly Grandmother's Condition?

Hello Mr. <br>Fang Hong Xiao Liang： Choking poses a risk of aspiration pneumonia; therefore, the use of a nasogastric tube (or gastrostomy tube) can help mitigate this risk. <br>Changhua Hospital cares about your health. <br>Chen Shidian.

Issues with Nasogastric Tubes

My grandmother is 85 years old and has mild dementia.
She is taking medication for Parkinson's disease and her consciousness and responses are normal.
She experiences post-nasal drip and thick phlegm, which she has difficulty coughing up.
She tends to swallow slowly while eating and drinking, and sometimes chokes and coughs if she takes too large bites or eats too quickly (eating slowly helps reduce this).
Recently, she was hospitalized due to a urinary tract infection.
She is unable to drink more than 2500cc of water, and if I don't feed her, she eats less and is more prone to choking on liquids.
An ENT examination with a nasopharyngoscope showed no tumors or food accumulation, which is attributed to aging.
It was recommended that she consume liquid or semi-liquid foods (I have been feeding her porridge, which she finishes).
However, after a consultation with the attending physician and the rehabilitation therapist, they suggested that we consider placing a nasogastric tube for her rehabilitation.
Given this situation, is it appropriate to place a nasogastric tube?

Fang Hong Xiao Liang, 30~39 year old female. Ask Date: 2010/11/29

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello Mr.
Fang Hong Xiao Liang: Choking poses a risk of aspiration pneumonia; therefore, the use of a nasogastric tube (or gastrostomy tube) can help mitigate this risk.
Changhua Hospital cares about your health.
Chen Shidian.

Reply Date: 2010/11/29

More Info

In considering whether a nasogastric (NG) tube is necessary for your elderly grandmother, it is essential to evaluate her overall health status, swallowing ability, and nutritional needs. Given that she is 85 years old, has mild dementia, and experiences difficulty swallowing, particularly with solid foods, the recommendation for an NG tube may stem from concerns about her nutritional intake and hydration.

Swallowing Difficulties and Risks: Your grandmother's slow swallowing and tendency to choke on larger bites or when eating too quickly indicate a risk of aspiration, which can lead to pneumonia and other complications. This is particularly concerning in elderly patients, as their ability to protect their airway may be compromised. The fact that she has nasal drainage and thick phlegm further complicates her swallowing and respiratory status.

Nutritional Needs: The recommendation for an NG tube may also be influenced by her inadequate fluid intake (less than 2500cc) and the need for consistent nutrition. An NG tube can provide a means to deliver nutrition and hydration directly to the stomach, bypassing the swallowing difficulties. This can be especially beneficial if she is unable to consume enough calories and fluids orally, which is critical for her recovery from the urinary tract infection and overall health.

Considerations for NG Tube Placement:
1. Temporary vs. Long-term Use: If the NG tube is intended for short-term use (a few weeks), it may be a reasonable option to ensure she receives adequate nutrition and hydration while her swallowing is assessed and potentially improved through rehabilitation. However, if the tube is suggested for long-term use, it may be worth discussing the potential for other feeding methods, such as a percutaneous endoscopic gastrostomy (PEG) tube, especially if her swallowing difficulties are expected to persist.

2. Quality of Life: It is crucial to consider your grandmother's quality of life. If the placement of an NG tube causes her distress or discomfort, or if it significantly impacts her ability to engage in daily activities, these factors should be weighed against the benefits of nutritional support.
3. Rehabilitation Potential: Engaging in swallowing therapy with a speech-language pathologist may help improve her swallowing function. If there is potential for her to regain the ability to eat and drink safely, this should be explored before resorting to an NG tube.

4. Medical Team's Perspective: It is essential to have open communication with her healthcare team, including her primary physician and rehabilitation specialists. They can provide insights into her prognosis, the expected duration of her swallowing difficulties, and the potential benefits and risks of an NG tube in her specific case.

In conclusion, while an NG tube may be appropriate for your grandmother to ensure adequate nutrition and hydration, it is vital to consider her overall well-being, the potential for rehabilitation, and the impact on her quality of life. Engaging in a thorough discussion with her medical team will help you make an informed decision that aligns with her health goals and personal preferences.

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