DÄ internationalArchive16/2008The Involuntary Weight Loss of the Elderly: Feeding in Very Advanced Disease

Correspondence

The Involuntary Weight Loss of the Elderly: Feeding in Very Advanced Disease

Dtsch Arztebl Int 2008; 105(16): 310. DOI: 10.3238/arztebl.2008.0310a

Gaertner, J; Ostgathe, C; Voltz, R

LNSLNS In the concluding paragraphs of their CME article, the authors point out that "PEG tube feeding is not a terminal or even symbolic measure in patients with a poor prognosis or incurable illness in its terminal stages." We want to emphasize this important point.

The emotionally charged measure of introducing or continuing artificial feeding is requested every day, in innumerable therapeutic situations, by patients as well as their relatives. Especially the plea from relatives, not to let the patient starve to death, requires a closer look.

It is indisputable that in secondary cachexia (e.g. tumor-related mechanical or neurological impairment of the act of swallowing) artificial enteral feeding via PEG can make perfect sense. The sensation of hunger does, however, not occur in primary tumor cachexia, and artificial feeding does not make a positive contribution to the patient's remaining lifespan or quality of life. Often, this measure only reinforces stressful symptoms owing to the fluid imbalances caused (ascites, pleural effusion, cerebral edema, etc). The same is true for advanced non-oncological diseases (1). Doctors are therefore not under obligation to instigate artificial feeding in this context (2).

With this letter, we want to lend additional emphasis to the final important paragraph of the CME article by Löser et al. We are hoping in this way to reduce uncertainties in decision making in favor of or against artificial feeding in the course of advanced disease and thus reduce automatic therapeutic responses. DOI: 10.3238/arztebl.2008.0310a


Dr. med. Jan Gaertner
Dr. med. Christoph Ostgathe
Prof. Dr. med. Raymond Voltz
Zentrum für Palliativmedizin
Klinikum der Universität zu Köln
Kerpener Str. 42
50924 Köln, Germany
1.
Mitchell SL: A 93-year-old man with advanced dementia and eating problems. JAMA 2007; 298: 2527–36.
2.
Bundes­ärzte­kammer: Grundsätze der Bundes­ärzte­kammer zur ärztlichen Sterbebegleitung. Dtsch Arztebl 2004; 101 (19): A 1298–9.
1. Mitchell SL: A 93-year-old man with advanced dementia and eating problems. JAMA 2007; 298: 2527–36.
2. Bundes­ärzte­kammer: Grundsätze der Bundes­ärzte­kammer zur ärztlichen Sterbebegleitung. Dtsch Arztebl 2004; 101 (19): A 1298–9.

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