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Severe dementia with aspiration and feeding decision — SCE Geriatric Medicine MCQ

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HardNutritionSevere dementia with aspiration and feeding decisionSCE Geriatric Medicine

A 92-year-old man with advanced dementia is admitted with poor intake and recurrent aspiration. He is bedbound, doubly incontinent and no longer recognises family; he pockets food and coughs with thin fluids. Chest X-ray shows right lower-zone consolidation, albumin is 24 g/L and his daughter asks for a PEG tube to prevent further pneumonia. What is the most appropriate management?

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Correct answer: B — Offer careful hand feeding with comfort-focused goals and discuss why PEG feeding is unlikely to prevent aspiration

In severe dementia, enteral feeding does not reliably prevent aspiration and may increase burdens such as restraint, tube complications and distress. NICE NG97 advises not routinely using enteral feeding in severe dementia unless there is a potentially reversible comorbidity. Careful hand feeding, mouth care and goals-of-care discussion are usually more appropriate. The pearl is that nutrition decisions should consider comfort, prognosis and the mechanism of aspiration.

Reference: NICE NG97; NICE NG31