Japan Moves to Limit Bedbound Elderly On Feeding Tubes

[FarCenter]

For the first time, Japan is trying to hold down the number of bedbound elderly people kept alive, sometimes for years, by feeding tubes.

Following news articles by Bloomberg News and others, the government is planning to cut payouts on insertions in new patients and encourage home care. About a quarter-million Japanese elderly live on feeding tubes. Faced with a heavy public debt burden, Japan is trying to curtail growth in a 38.5 trillion yen ($376 billion) annual health bill by releasing patients from hospitals faster.

The health ministry also plans to boost reimbursements to institutions that check swallowing ability and encourage rehabilitation to help the bedridden eat by mouth. The changes, effective April 1, mark the first time Japan has cut government reimbursements for the practice.

“Eating is one of the most important human dignities and the country is moving forward to protect it,” said Kazuhiro Nagao, a doctor and deputy director of the Japan Society for Dying with Dignity.

The use of feeding tubes at the end of life, which isn’t standard practice in the western world, is common in Japan, the world’s fastest aging society. They often prolong the lives of terminally ill or dementia plagued Japanese elderly, and the ministry says almost a quarter of people nourished via a tube to the stomach were given one without an evaluation.

http://www.bloomberg.com/news/2014-03-23/japan-moves-to-limit-bedbound-elderly-on-feeding-tubes.html

[TexasTowelie]

1. Because they can run to McDonalds instead?

Yes, very dignified.

[Hoyt]

2. Economics forcing a lot of countries to do things previously unimaginable. Not Obama's fault

this time, although I'm sure some will try to pin it on him.

[JimDandy]

3. So the incredible number of Japanese who live long lives

is actually because of feeding tubes and not the fish/rice and low fat diet we aways hear is the "secret" to their longevity.

[FarCenter]

4. It may extend the average life by a few months

More than 90 percent of the 260,000 Japanese patients estimated to be fed through a tube are bedbound, according to a survey by Japan’s hospital association. They are, on average, 81 years old and nourished by tube for 2.3 years.

Most of the elderly who get put on stomach tubes in Japan never get taken off them. While almost a quarter of those fed via a tube to the stomach had the potential to eat by mouth again, only about 2 percent of them did so and had the tube removed, according to a study funded by the health ministry.

Although for the fraction that get put on feeding tubes, 2.3 years does seem like a long time.

[JimDandy]

14. Hmm... 2.3 years isn't enough to account, though,

for the difference in life longevity between the US and Japan, so perhaps their diet/lifestyle is something to emulate after all.

It IS a long time for someone to be on a feeding tube alright. Eta: down thread someone said their relative survived for 4 years on a feeding tube.

[Jesus Malverde]

10. wow...nt

[Nye Bevan]

5. What an awful way to end your life.

I would prefer to die with dignity.

[Jesus Malverde]

7. Being on a feeding tube is not a terrible way to live

Humans are remarkable in terms of what we can adapt to.

[pipi_k]

11. For some people...

being on a feeding tube is a terrible way to live.


Maybe not for you, but for someone else, yes.

Terrible and totally undignified

[Jesus Malverde]

12. Is being on an oxygen tube terrible?

Is being on an insulin syringe terrible?

I think it has to do a lot with the context of where and how the treatments are applied.

If I'm elderly and with limited mobility being on a feeding tube would be better than death.

[pipi_k]

16. Like I pointed out...

it might not be terrible FOR YOU, but for others it would be.


I really hope you're not trying to make a case for what others should do based on your wishes.

[Jesus Malverde]

20. Someone close to me is on oxygen and I hope she lives a long time.

We deal with it and hope for the best. Death is not our alternative.

Being on oxygen or a feeding tube is very different from being on a ventilator. Maybe thats the confusion.

People can lead good lives on a feeding tube or oxygen dependent.

[pipi_k]

28. Actually that's not

the confusion at all.

When my MIL was living here she eventually had to be on oxygen.

She hated it and was always pulling off her breathing tubes.


When she got bed bound and had to be catheterized, she hated that, too. One morning we discovered that during the night she had: taken off her nightgown, pulled off her oxygen tubes AND pulled out the catheter tube. The same tube that had a small balloon on it inside her bladder to prevent it from being pulled out. Must have hurt like hell when she did it. But she hated it.


Many people don't adjust to/cope with being hooked up to machines and tubes...

[840high]

38. I watched a man

die - after his family requested feeding tube be removed. Took days for him to die. I called it torture.

[pipi_k]

43. OK...

you call it "torture".

My MIL didn't eat for over two weeks before she died.

Couldn't drink water for a week before she died, although we used those sponges on a stick and lip balm.


It wasn't the lack of food that killed her. If anything, it was the fact that she could no longer take in liquids by mouth.

She died peacefully as Mr Pipi...her son...and I held her hands.


I guess different people will see different things.

[840high]

45. I'm glad she died

peacefully.

[malaise]

8. That's why we have living wills

None of that crap for me.

[pipi_k]

15. My MIL had one

And thank goodness for it.


When she broke her second hip in 2004 at the age of 93, her own doctor wouldn't sign her up for hospice care, even though he knew...or should have known...that the prognosis for a broken hip in the elderly is often not very good. Six months at best.

She was having a LOT of trouble with her meds and dementia and all sorts of things.

It took yet another visit to the ER, and a compassionate ER doctor who could see what was going on. We showed him her living will. She was put on hospice care in our home.

She died peacefully and with dignity, just as she wanted to, in 2005.

[malaise]

27. My mom died 20 years ago come July

and she had her living will - it silenced all those who wanted to keep her going.
And she died peacefully - as she lived.

[pipi_k]

29. I'm so glad

she had a peaceful passing.

I really wish my dad had had a living will too.

He wanted to die at home, but his wife (not my mom) either couldn't care for him, or didn't think it was important to him.

He passed away in 2002 after being disconnected from all the machines he had been on for nearly two weeks. It hurt to lose him, but it hurt even more to know that he probably was not at peace on those damned machines.

[adirondacker]

32. Same for me..."30 percent of seriously ill people surveyed in a hospital said they would “rather die

than live permanently in a nursing home."

This story touches on a lot of emotion involved in caretaking and end of life decisions...

http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=all

[malaise]

33. I'm not spending one single day in a nursing home

Not one

[pipi_k]

34. Me neither...even

the cleanest, well-staffed, and most cheerfully decorated of them are still depressing beyond belief.

My heart breaks whenever I see one on TV where the residents/patients are allegedly "having a good time" singing songs, doing exercises, crafts, etc.

Bullshit.

[adirondacker]

35. Careful. That's what my mother said and I did my best to keep her out of one.

She had a series of mini strokes that she didn't tell anyone about. I started suspecting things but thought it may be depression due to my sister being diagnosed with terminal cancer. It wasn't until "she couldn't" come to assist in caretaking my sister in AZ that I knew something more serious was going on. I came back from caretaking my sister to take on doing the same for her. I lasted 7 years and had to make the tough decision to place her due to her advanced incontinence and the effects it was having on my own life.

She has been in a nursing home for the last 15 months and adapted quite well (she was in stage 6 of 7). It's a small Catholic run home that is set up like apartment living and is well kept. I was pleasantly surprised by the lack of smell and the staff is genuinely friendly and helpful. She made friends with a wheelchair bound patient and wheels her around for a good part of the day. She also folds laundry and participates in a lot of the activities that they have. She always lived life with a purpose to help others and it remains so. When, and if, she hits the wall of becoming incapacitated enough to swallow, that will be the end. Only because I know that is what she would want.

I have a good friend that has gone through the situation with his father for 14 years, and now his mother (he has a sibling that share the burden). He reminded me that you "never know" how things in life are going to turn out. I have a living will in place, but that doesn't guarantee keeping me out of a nursing home.

Best of luck though!

[malaise]

39. I get your point

You're a good human being for doing your best.

[adirondacker]

41. Most of us want to exit peacefully without burdening others.

Statistics prove otherwise.

Carpe Diem and what will be, will be.

I So enjoy reading your posts btw!

[FrodosPet]

9. My dad spent the last 4 years of his life on a tube after his stroke

He hated the pump, so I had to manually feed him 7 to 8 cans of product per day, over 3 or 4 feedings, by injecting it with a big syringe. As well, all his pills had to be crushed into the finest possible powder before injecting it in the tube. Some of those suckers were little rocks! Infections and blockages were a big mess, and having the occasional tube come out, with stomach acid following - that will put you in panic mode in a BIG hurry.

My sympathies for anyone who has to care for someone on a feeding tube, as well as those on the tube.

[Jesus Malverde]

17. its not clear from your post if the tube was more terrible for you or your dad.

Seeing as he lived on for four years I assume on some level he dealt and coped with it.

[FrodosPet]

30. Not like you have much choice!

It was terrible for him, because no matter how clean you try to keep the entry point, you WILL get infections. And there were only certain brands of food that he could tolerate. Some would give him some nasty tasting burps. One even made him vomit, and for someone with half their body paralyzed, that is NEVER a good thing.

And, since you aren't eating or drinking by mouth, it is a challenge to keep your mouth from drying out. He had some special wipes on a stick to use to clean and moisten his mouth, but it is not the same as drinking a nice big glass of anything.

I'd have to say it sucked pretty bad for both of us. Being a 24x7 caregiver a for a major part of four years (other than a couple 90 day nursing home rehab stints) helped extend his life, but the process has probably trimmed some off of mine. I STILL feel tired and emotionally drained from that period, and it was 10 years ago since he passed.

Blessings and love to anyone caring for others. Please be strong. Please seek out love and support...DON'T try to carry that weight alone.

[Jesus Malverde]

31. .

[adirondacker]

37. !

[Jesus Malverde]

6. Pneumonia from food aspirated into the lungs is a major killer of elderly.

It's likely this new policy will encourage that trend.

[JimDandy]

19. That's what my relative's Dr told us when we asked to

to have the hospital insert a feeding tube into her. She was constantly choking on her food when trying to swallow it. We ended up not inserting one mostly because of that reason and that she wouldn't be able to talk. She wasted away within months and never got home again before she died at age 95. It was wrenching to watch her suffer simply trying to eat.

[Jesus Malverde]

22. I'm under the impression for food risk pneumonia a tube is safer than eating.

Watching anyone suffer is terrible.

[Barack_America]

21. What would you prefer they die from?

Because, you know, we all have to die. Aspiration happens to be a very "natural" way to go.

[Jesus Malverde]

23. I think if you have a choice between dying of food aspirated pneumonia or going on a tube for a

couple years the tube would not be a bad alternative.

[Octafish]

13. Sounds like Goldman Sachs talking austerity is good for Japan.

It's not like they own the world or nothing.

[Jesus Malverde]

25. This is interesting for Japan.

A society that is very deferential to it's elders.

In some ways its a toxic mix of the medical system outlasting the pension/elderly support system.

Boomers beware.

[Nuclear Unicorn]

18. From the personal stories in this thread I just want to say

I'm not going to say who is right, who is wrong or what needs to be done.

All I want to say is: Love your people as much as you can for as long as you can.

[Jesus Malverde]

24. Thanks NU

[Erich Bloodaxe BSN]

26. If there are people on feeding tubes who aren't

at risk for aspiration, and can safely eat without a tube, they certainly should be doing so. Overtreatment resulting from sloppy or neglected medical evaluations is a concern the world over, not just in Japan.

[KamaAina]

36. How do you say "death panels" in Japanese?

Or "Fox", for that matter?

[jwirr]

40. First of all I want to know what type of feeding tube? The ones that they shove down your throat or

ones that have been placed in the stomach? I would not be willing to obey this law if it is the latter since my daughter who is now 56 years old has been on one for at least 10 years. She has always had digestive problems (similar to the ones that killed the Janesville WI child who was 15 years old and died weighing 15 pounds). My daughter was 45 pounds when we put the tube in and now maintains at 85 pounds. Not enough but enough to make her look much more healthy. I would not want this to apply to her and others like her.

[FarCenter]

42. The article refers to "stiching up the incision" upon removal

So this would be gastric feeding tubes.

[jwirr]

44. Okay. I hesitate to say they are totally wrong limiting this use. Not for the young like my daughter

but why are so many elderly using them? We have just recently seen a case where the patient was kept alive even though brain dead. Is this what is happening there? I guess we would need to know what their culture teaches regarding this law. In this country if I can have a living will that bypasses any of this type of life prolongers. Do they have that right over there? There is a lot we do not know.