By Dave Andrusko

Talk about carefully reading between the lines. The article in yesterday's New York Times is headlined, "Feeding Dementia Patients With Dignity," and is written by Roni Caryn Rabin.

Sparked by a recent paper in The Journal of the American Geriatrics Society, there are many tender passages and gentle acknowledgements in the story that as our population ages there will be increasing numbers of us Baby Boomers whose cognitive setbacks will mean we'll be unable to feed ourselves.

According to Rabin, the "quandary" (of "whether or not to have a gastric feeding tube inserted") "which usually arises near the end, when Alzheimer's begins to destroy the part of the brain that controls eating -- is often presented as a stark choice between providing nourishment and withholding it." Using the case of a particular woman and her mother, Rabin argues there is a third way-- "comfort feeding only"--which is "to have her mother carefully fed by hand, giving her only as much as she wanted and stopping if she started choking or became agitated."

I'm no expert, by any stretch of the imagination, but a couple of concerns came to mind, prompted largely by the individual who forwarded the column to me and many others.

Who would at first blush disagree with this? "We believe careful hand-feeding is a much more humane way of taking care of these people, and preserves the patient's dignity," as an author of the paper, Dr. Joan Teno, a professor of community health at Brown University's medical school, told the Times. "They can still have that human interaction and intimate contact that comes with being fed."

The dilemma is, as illustrated by anecdotes in the story, that this feeding by hand can take a long time. What if the patient doesn't have family and/or is in a facility with constant staff turnover? Add to this the possibility that the controlling ethos is that patients aren't going to "get better" anyway and the chances of the patient dying from lack of proper nutrition (and medications) are substantially increased.

And as was pointed out by the individual who sent this article along, hand-feeding is out of the question for brain-injured patients who cannot swallow.

Rabin ends with the story of an 86-year-old gentleman who has hand-fed his wife for years and years.

"Some days are better than others," he said. "The food is puréed, and she doesn't eat a full meal. But I always give her at least half a banana every day, and strawberries in season." \

"The bottom line is she doesn't go hungry," he said. "She looks good."

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