Abstract
Dementia is a growing public health issue, with the number of cases projected to triple by 2050 as society ages. Although the American Geriatrics Society recommends careful hand feeding over tube feeding for patients with advanced dementia, an increasing proportion of patients are receiving tube feeding. Although decisions regarding tube feeding are often based on the physician, recent studies have shown that tube feeding has significant implications for clinical outcomes and quality of life. Tube feeding is associated with an increased risk of mortality, pneumonia and the use of restraints. Although tube feeding may reduce caregiver burden, it does not improve survival or nutritional status and incurs significant financial costs. Caregivers that hand feed patients often experience stress, particularly in regions where support services are limited. However, there are various strategies available to promote hand feeding which include environmental interventions, mealtime assistance and caregiver training. Although hand feeding is the most comfortable option for patients, the frequency of mealtimes and financial and mental health impact on caregivers requires the physician to conduct a holistic assessment of the patient when deciding on the mode of feeding for patients with advanced dementia.