My Father has now passed away after a very distressing 20 months of end of life care. He was diagnosed with Vascular dementia in 2013 but had a catastophic stroke in 2016 which he never recovered his swallow reflex from. He was fitted with a PEG against our wishes and there followed the long drawn out end to his non existent quality of life. I am trying to get his and the family's story told in the hope that lessons can be learned for other patients and families in the future. I read about other peoples experiences of end of life in Dementia as far as the not eating and losing the swallow reflex,and,it is all very sad and distressing for the family's watching,and hard to accept it is part of the end of life process,but,being artificially fed via a PEG at end of life is not natural,and ultimately prolonged the agony both for my Father and us,his family. Have others had experience of PEG fed patients with Dementia/stroke? Thank you for reading
Peg feeding?
- Thread starter treelife
- Start date
Welcome to TP @treelife
My condolences on the loss of your father, I’m sorry you feel that some of his care was not as you would have liked it to have been, those feelings can be hard to deal with.
The issue concerning PEG feeding in a very contentious one, my view and that of many here on TP is that on the whole it is not usually appropriate but there will always be an exception to that thought.
I hope you can find some peace at this difficult time.
My condolences on the loss of your father, I’m sorry you feel that some of his care was not as you would have liked it to have been, those feelings can be hard to deal with.
The issue concerning PEG feeding in a very contentious one, my view and that of many here on TP is that on the whole it is not usually appropriate but there will always be an exception to that thought.
I hope you can find some peace at this difficult time.
Thankyou nellbelles,yes it has been and still is difficult to deal with especially as my Father was very vocal(when he could still speak) about his thoughts and feelings on end of life and what he would want. He was refusing the PEG too,although couldn't communicate that verbally.Because of the dementia the doctors couldn't be sure he understood what his situation was.We were told although they would seek our consent,it would be a medical decision,which is what it became.I strongly suggest he was 'bed blocking' as he was medically classed as stable,and that nursing homes don't take nasal fed patients.His care once he got into the nursing home was ok,his condition was very difficult to manage and there was a lot of confusion as to what constituted 'intervention'. we were told on one hand that there would be no more interventions or treatments of infections etc,but he had several bouts of antibiotics and anti sickness,muscle relaxants etc etc,but these weren't 'interventions' as such,as they could be administered via the PEG,they were to keep him 'comfortable'. i don't feel he was ever 'comfortable'. We,the family feel,he was kept alive for those 20 months unecessarily when he could have had a more natural end of life( he was given a 2 to 3 week prognosis originally)
His passing has been a relief for the most part,we did our grieving when we lost him in april 2016,but the anger and guilt still remain for the moment.
His passing has been a relief for the most part,we did our grieving when we lost him in april 2016,but the anger and guilt still remain for the moment.
A friend of mine, aged 72, had a major stroke in late January, and lost his swallow, he pulled out the nasal feeding line 3 times overnight, so a PEG was put in place.
When I visited him 3 weeks after his stroke I couldn't tell if he recognised me (his partner said he did) although he did wave bye to me as I left. I visited him again last weekend, another 4 weeks on, he recognised me, tried to talk, reacted to the things I said, looked at photos on my phone. His partner has now got the Eurosport channel running on his ipad and he is enjoying watching it.
Feeding wise, on my first visit after 3 weeks I was told he was taking in teaspoons of yoghurt 7 times a day, and on my recent visit he was being spoon fed soft food, having worked his way through puree and mash. The PEG is still in place for now.
The big difference, I guess, is there was no dementia prior to the stroke, I spent the weekend with him (he had the stroke on a Monday), and he was hillwalking in thigh deep snow on the Friday, cycling on the Saturday, partying saturday night, he was canoeing twice a week, however he has had compromised lung function for over 30 years and I suspect with lack of activity this will now cause problems.
I know that progress can be made following a stroke for many months, and in my friends case I hope that is what happens. Initially he had no movement down one side, I don't know where that is up to.
I am aware from comments on TP that a PEG is not a good way forward in dementia, but maybe as he was on a stroke ward it is a different protocol. I think dementia is just not understood properly by those that haven't had direct experience of it, which includes many hospital staff and this may be what happened in the stroke ward.
I hope that this helps for a stroke perspective.
When I visited him 3 weeks after his stroke I couldn't tell if he recognised me (his partner said he did) although he did wave bye to me as I left. I visited him again last weekend, another 4 weeks on, he recognised me, tried to talk, reacted to the things I said, looked at photos on my phone. His partner has now got the Eurosport channel running on his ipad and he is enjoying watching it.
Feeding wise, on my first visit after 3 weeks I was told he was taking in teaspoons of yoghurt 7 times a day, and on my recent visit he was being spoon fed soft food, having worked his way through puree and mash. The PEG is still in place for now.
The big difference, I guess, is there was no dementia prior to the stroke, I spent the weekend with him (he had the stroke on a Monday), and he was hillwalking in thigh deep snow on the Friday, cycling on the Saturday, partying saturday night, he was canoeing twice a week, however he has had compromised lung function for over 30 years and I suspect with lack of activity this will now cause problems.
I know that progress can be made following a stroke for many months, and in my friends case I hope that is what happens. Initially he had no movement down one side, I don't know where that is up to.
I am aware from comments on TP that a PEG is not a good way forward in dementia, but maybe as he was on a stroke ward it is a different protocol. I think dementia is just not understood properly by those that haven't had direct experience of it, which includes many hospital staff and this may be what happened in the stroke ward.
I hope that this helps for a stroke perspective.
Hi Jugglingmum.Yes,agreed,for stroke patients PEGs are used very regularly until the swallow reflex has returned and then can be reversed,which I also saw in the 2 months that my Father was in hospital,so I know it does work,and can be a 'nicer' option than nasal tubes. In my Fathers case,it was absolutely clear that he was never going to regain any swallow reflex again,and all therapies had already been stopped.His stroke was 7th april,his PEG fitted after the consultation that agreed he wasn't going to recover on 30th may,he was in a home 7th june.On top of that he had the dementia,which we can only presume had been accelerated by the stroke,because there was no way of guaging how much as he had no communication skills.I think the family should have been consulted properly,and,if needed,a second opinion offered,rather than a 'medical' decision it should have been a best interests of patients decision.Once it was fitted,there was never going to be a way back or reversal for him.Instead it prolongued a life that had no quality to it.Yes,we had another 20 months of him,but at such a cost.The question was asked on many occasion by 'people' why was he ever fitted with a PEG in the first place,but I am very aware it is such a difficult,ethical,medical and controversial immotive subject,I do have sympathy for those making the decisions.
In your dad's medical circumstances I totally agree with your post..this would not have been something I would not have wanted for my dad or indeed myself in my dad's case. I am of the opinion that it prolongs death not life and just because we can doesn't mean we should. Did you have health poa for your dad and if so they should have heeded your dad's wishes through you? I made the right and kind decision with the consultant to stop iv antibiotics and fluids which I knew would bring dad to end of life. A resident at dad's NH has been peg fed for over 3 years. The Drs in hospital did not want to start peg feeding so opposite to your experience to let nature take its course in advanced dementia but the family who I got to know well insisted that he was started. In that time he has been into hospital with infections from both the cafeter and peg feed entry.. The family would argue that the odd murmer or change in facial expression is enough to show he has a quality of life and given every chance and they refuse to agree to dnr..I feel it is more about his family not wanting to let him go and it just seems cruel as he cannot do anything but lay in bed unable to move other than occasional arm movements but everyone makes their decision for what they feel are their valid reasons. I think the medics are concerned about litigation but it seems perverse to me that you read about sad cases of children whose parents naturally fight to the last breath to stop life saving treatment being withdrawn in similar lack of quality of life opinion yet an elderly infirm patient who will eventually succumb to the dementia and associated medical decline they want to intervene in nature taking its course when they also have no quality of life. Intervening to keep a patient pain free and comfortable is of course different but I too would have been very disappointed as you.
Dear treelife,
I am so, so sorry for your very painful and traumatic loss. I am so sorry for all that you have been through - to watch someone you love suffer is appalling. In my case, the consultant said that a nasal tube and peg feeding were not in my mum's best interests and I agreed (although life without her now is torture but she died two weeks after, unlike your poor father).
Could you make an appointment to see the team involved with your father's care - to get some more clarificaiton on the reasons why they took the action they did in your case, and maybe to raise their awareness of the issue for other families. It does seem very strange that they would go against your wishes and I wonder what it is that they saw in your dad's situation that meant that PEG feeding was appropriate.
I cannot imagine, in the advanced stages of dementia, that artificial feeding would ever be a good idea. As you say, the life is prolonged but at what cost, especially when the poor patient has no clue what's going on.
I know when my father died, I made a complaint about his nursing care and I met the senior nursing staff in response. So, if you feel passionate about finding out more and have the energy to do so, I would raise a complaint or just ask to make an appointment with the Consultant. It is your right to do so.
I can imagine the pain you are in at losing your dad, but those memories of his care will be torturing you, I have no doubt. I hope you know it wasn't your fault, that it was out of your hands. This may be of little comfort to you at this time. Best of luck and keep posting - we are here.
I am so, so sorry for your very painful and traumatic loss. I am so sorry for all that you have been through - to watch someone you love suffer is appalling. In my case, the consultant said that a nasal tube and peg feeding were not in my mum's best interests and I agreed (although life without her now is torture but she died two weeks after, unlike your poor father).
Could you make an appointment to see the team involved with your father's care - to get some more clarificaiton on the reasons why they took the action they did in your case, and maybe to raise their awareness of the issue for other families. It does seem very strange that they would go against your wishes and I wonder what it is that they saw in your dad's situation that meant that PEG feeding was appropriate.
I cannot imagine, in the advanced stages of dementia, that artificial feeding would ever be a good idea. As you say, the life is prolonged but at what cost, especially when the poor patient has no clue what's going on.
I know when my father died, I made a complaint about his nursing care and I met the senior nursing staff in response. So, if you feel passionate about finding out more and have the energy to do so, I would raise a complaint or just ask to make an appointment with the Consultant. It is your right to do so.
I can imagine the pain you are in at losing your dad, but those memories of his care will be torturing you, I have no doubt. I hope you know it wasn't your fault, that it was out of your hands. This may be of little comfort to you at this time. Best of luck and keep posting - we are here.
Thank you lambchop. The situation at the time was that my Father although had no swallow,speech reflex or mobility,and was never going to recover,he was being nasally fed,but 'refusing' (difficult to explain when he couldn't communicate verbally),but he would grimace and move his head not to allow nasal tubes to be refitted and shook his head in refusal. The consultant said that he was medically stable enough to go to a nursing home for his end of life care,but they don't take nasal fed patients,therefore a PEG was only option as they couldn't be seen to 'starve' a patient if there was a way to get nutrition in.We,the family,said no,we didn't want it,nor would he,but the consultant advised us that they would prefer our consent but that was now a medical decision and as we didn't have health POA in place it went ahead.When you are in these situations for the first time,we didn't know you could possibly get 2nd opinions etc?
I did ask several questions about his care throughout the 20 months that the PEG kept him alive,but it was always met with we are doing our best to keep him comfortable,he was never comfortable despite their best efforts.
I have got a meeting set up with the end of life consultant to discuss things,but I am very mindful not to be seen to be complaining,I just want some clear answers and hope some lessons can be learned(if our experiences were 'normal' for future patients and families that sadly find themselves in a similar situation. Which is why I am asking about other people's experiences to see if our experiences are normal practice or not.We have since lodged a health lasting Power of attorney for our Mother so that this cannot happen again.
HI treelife, it brings a lump to my throat to read your story. I still do not understand their reasoning when they could see how distressed your father was. And I am sorry at how much distress this situation is, and was causing you and your family.
I don't know whether it's down to each Consultant team, each NHS Trust etc whether such treatment takes place or not. My mother was in UCLH in London and there was no question of any type of feeding.
As well as the Consultant's views, what did the palliative care team say?
As for the meeting, well done for setting this up. To be honest, I would encourage you to make a complaint but, of course, that is up to you. In any case, I hope you get some answers. It seems clear that care of this nature is not standard across the NHS. But, in the absence of clear instructions in someone with dementia, the wishes of the family should be paramount, as well as minimising the suffering of the patient. It also seems to me that the Trust's palliative care pathway needs reviewing and, with the meeting, we can only hope that they will review it.
Well done as well for getting the POA for your mum. I did not have one for my mum but thankfullly, I did not need it.
Please keep us updated - we are thinking of you at this horrible time.
I don't know whether it's down to each Consultant team, each NHS Trust etc whether such treatment takes place or not. My mother was in UCLH in London and there was no question of any type of feeding.
As well as the Consultant's views, what did the palliative care team say?
As for the meeting, well done for setting this up. To be honest, I would encourage you to make a complaint but, of course, that is up to you. In any case, I hope you get some answers. It seems clear that care of this nature is not standard across the NHS. But, in the absence of clear instructions in someone with dementia, the wishes of the family should be paramount, as well as minimising the suffering of the patient. It also seems to me that the Trust's palliative care pathway needs reviewing and, with the meeting, we can only hope that they will review it.
Well done as well for getting the POA for your mum. I did not have one for my mum but thankfullly, I did not need it.
Please keep us updated - we are thinking of you at this horrible time.
Sadly lambchop,I do feel absolutely,that it was a case of the consultant was under pressure to get the bed freed up(as was mentioned several times) and the PEG option was the way forward. Stroke on 7th april,Peg not fitted til may 30th,after absolute clinical assurance he was never going to recover,in care home 7 days later! Very clear to us this was not a best interests of patient decision in the first place. We,as a family,are not for complaining,we did ask many questions which were seen as complaining throughout.I just want his story heard in the hope big lessons can be learned moving forward.I will see what happens at the meeting,but feel cynical at this stage that it has been agreed to have meeting to keep the family "happy" ,wait and see.Thanks for listening.
Hi Treelife.
This is a difficult situation and much more complex than it seems.
Whilst it is considered appropriate to not artificially feed end stage dementia what do you do if the swallow deteriorates secondary to a stroke?
It may seem simple to just let nature take its course but is that in the 'best interest' of the person?
Now, often the family can give their opinion on what is best for the person but if there was no advanced directive written in place how can the medical team be sure?
This situation represents one of the most complex decisions that a medical team will have to handle and it is impossible to get right every time. Additionally not all family will agree on a clear decision which then falls back to 'best interest for the person'.
One area that has not been explored is if the person with the stroke has not improved, would it be ethical to remove the PEG tube at a later date. Much more difficult to withdraw nutrition when it is already in place.
Sorry you had to go through this experience and hopefully time will sooth the scars. Raising the issue will be in everyone's interest.
This is a difficult situation and much more complex than it seems.
Whilst it is considered appropriate to not artificially feed end stage dementia what do you do if the swallow deteriorates secondary to a stroke?
It may seem simple to just let nature take its course but is that in the 'best interest' of the person?
Now, often the family can give their opinion on what is best for the person but if there was no advanced directive written in place how can the medical team be sure?
This situation represents one of the most complex decisions that a medical team will have to handle and it is impossible to get right every time. Additionally not all family will agree on a clear decision which then falls back to 'best interest for the person'.
One area that has not been explored is if the person with the stroke has not improved, would it be ethical to remove the PEG tube at a later date. Much more difficult to withdraw nutrition when it is already in place.
Sorry you had to go through this experience and hopefully time will sooth the scars. Raising the issue will be in everyone's interest.
I had poa health for dad and it gave me more authority to speak for dad on 2 hospital stay occasions and other more minor interventions however if as attorney what I wanted wasn't in dad's best interests then quite rightly the professionals view is what counts. However the decision has to be justified and they have to prove it is in the donors best interests. Dad like yours could not verbally communicate his pain or wishes and 8 months into his NH it was clear over a few weeks a hernia was causing him great distress and physical problems. He was taken into hospital as it was felt a strangulating life threatening situation was not far from happening. We felt the dementia was declining and eventually would being end of life and it was about getting dad pain free now and accepting as his post op risks were very high due to heart problems it should go ahead and his chances were higher as planned op rather than emergency. The surgeon agreed and said if it was his dad he would want the op. The first anaesephetist refused as he was so concerned about the risks...we understood and respected that..the second anaesephetist readily agreed and said he had dementia in his family and totally agreed with our reasoning. So a very compassionate and sensible surgical team. Dad came through fine and had 2 years of pain free hernia life. We knew dad would have wanted to take that risk...he had heart surgery and previous hernia and gall bladder ops...so as attorney we legally could speak for him. At end of life I and his consultant after being in hospital as an emergency with sepsis advanced dementia and a stroke decided to stop iv antibiotics and fluids as it wasn't in dad's best interests and he went back to NH for a peaceful painfree last week. I and my OH have
Health poa as well as Finance in place and as your post and my experiences show you don't know you need it until you do. Many get by without but for me I don't want to take that chance.
I am so sorry for your experience and for your dad...where is the humanity in some of these decisions. I wonder though whether as he was already nasally fed that made a difference as he was already being artificially fed and so it wouldn't be starting treatment just continuing by a different method and that complicated it in view of ethics and risk of litigation rather than common sense and compassion being applied
Health poa as well as Finance in place and as your post and my experiences show you don't know you need it until you do. Many get by without but for me I don't want to take that chance.
I am so sorry for your experience and for your dad...where is the humanity in some of these decisions. I wonder though whether as he was already nasally fed that made a difference as he was already being artificially fed and so it wouldn't be starting treatment just continuing by a different method and that complicated it in view of ethics and risk of litigation rather than common sense and compassion being applied
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As others have said, it is a very complicated situation and you are obviously doing everything you can to get more answers and to raise awareness of this issue for other carers. Thank you for doing this. I wasn't aware that there could have been an issue of bed-freeing which could have coloured the care given to your dad.
In my mum's case (with loss of swallow following stroke in dementia) the SALT (speech and language therapist) had very quickly ruled out a likelihood of her swallow returning, so mum wasn't nasally or peg fed,. I do wonder whether having dementia makes that diagnosis easier than for someone without dementia.
You obviously did everything you could to help your dad and it was taken out of your control, very unfortunately.
Anyway, the very best of luck and I hope you get somewhere with your meeting.
In my mum's case (with loss of swallow following stroke in dementia) the SALT (speech and language therapist) had very quickly ruled out a likelihood of her swallow returning, so mum wasn't nasally or peg fed,. I do wonder whether having dementia makes that diagnosis easier than for someone without dementia.
You obviously did everything you could to help your dad and it was taken out of your control, very unfortunately.
Anyway, the very best of luck and I hope you get somewhere with your meeting.
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Thank you,Yes,we are hoping from this meeting is to get a better understanding of why these decisions were made at the time,and why couldn't we,his family,who were ALL in agreement,have more of a say in what happens to our Father when he had no physical voice,and should we have been allowed more time to get a second opinion for instance,and,if that is the case,why were we not told his/our rights?. and after that,clarity on many aspects of his care thereafter and who decides when a patient is 'comfortable' . Certainly what would have helped would have been someone like a key worker who the family could liase with and ask questions of.And moving forward,hopefully some of our negative and distressing experiences will have an impact and help other families have a 'better' time of it in what is already a very difficult time,which will be a first for most.Meetings not til next week,so will keep in touch.
So I had the meeting with end of life consultant. She did listen to our story and was sympathetic to our distress throughout the process. These professionals are trained to be guarded I suppose ,and not give anything away as far as if our experiences were ' normal' (for want of a better word),but I got the strong impression that at time of PEG being fitted to my Father,there should have been the opportunity to have a discussion with all the family,certainly such a big decision should not have felt so rushed and just maybe our Father's end of life could have taken a different path,who knows? Following on from that,the lack of communication and confusion over his care could have been managed much better,which wouldn't have helped my Father,but,it definitely would us,the family. Anyway,moving forward I feel it was strongly felt lessons can be learned from this,our experiences will be put forward to the wider teams involved and hopefully some changes will be put into place for future families and patients.In turn,it may help us,his family,feel less guilty about maybe not 'shouting loud enough' for my Father and that some good can come out of it,let's hope so.
Thank you for your update. I’m so sorry for the situation you had to endure with your father but hopefully the Dr’s and team you met with will all learn from this too. You are doing a very good thing raising awareness amongst the carers here. An advance directive may be the way forwards but often we don’t think of things like this routinely with dementia as we do with other terminal illnesses, and when we do it may be too late to really explore the person with dementia’s true feelings. Obviously the family, like yourselves would know best.
I think it may be a little bit of a lottery which Dr you get and what their thinking is and the area in which they work. I work in palliative care and a lot is being done to make practioners aware of some of the issues that arise with dementia. Usually I find myself on the opposite side as you with relatives wishing to keep a loved one alive at all costs, no matter how futile it is. I think, or hope you would find those working in a palliative care setting much more sympathetic to a situation like your own.
So often communication is the key and I do hope you can now get some peace from your distressing experience. Please do not feel guilty, you were always there for your dad with his best interests at heart and I do feel others will benefit from your sharing your experience. Xx
I think it may be a little bit of a lottery which Dr you get and what their thinking is and the area in which they work. I work in palliative care and a lot is being done to make practioners aware of some of the issues that arise with dementia. Usually I find myself on the opposite side as you with relatives wishing to keep a loved one alive at all costs, no matter how futile it is. I think, or hope you would find those working in a palliative care setting much more sympathetic to a situation like your own.
So often communication is the key and I do hope you can now get some peace from your distressing experience. Please do not feel guilty, you were always there for your dad with his best interests at heart and I do feel others will benefit from your sharing your experience. Xx
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Sorry for your loss Treelife.
My husband passed away in March in 2016.
My husband was admitted into hospital around jan/Feb time with yet another infection. He was on thickened drinks and puréed food because of his near existent swallow. The consultant was requested to see him by the doctor looking after him. The consultant asked me about how he was coping eating. I explained that he was very unresponsive but when the spoon touched his lips he opened his mouth so to me he still wanted to eat. The consultant said my husband had suffered for a long time and would it not be kind to let him go. My answer was no and I asked about peg feeding. I certainly was not ready to let him go.
The consultant was very much against peg feeding but said if that was my wish he would back me. Apparently some one somewhere else would have the final decision.
I went to his nursing home to update them and talked to them about the peg feeding. She Manager who was a nursing sister said she too would be against anyone with dementia being peg fed. So as a family we went with the advice and peg feeding was forgotten.
I am glad now because it would have just prolonged the inevitable and there would have been no benefit to my husband. Less than two months later after yet another trip to hospital and having a really caring doctor look after him we had a very frank conversation with the doctor and he asked me where would I like my husband to be when his time came. Back in his nursing home was my reply and he said well let’s get that sorted now. My husband arrived by ambulance at 11pm back in his nursing home and passed away just after 1am.
Although I wanted the peg feeding, I realise it was for me not my husband and am glad that I took notice. There would have been no gain for my husband and I can fully understand your concerns re your Father and his treatment. Peg feeding does have its place but not with dementia. I wish you well and you can get satisfaction and closure.
Thank you. My Father had always been very clear and concise on his thoughts and wishes for end of life. Having made this clear in telling family and friends,and in his diaries,we felt more able to voice his opinions in the absence of his voice at the time(and they were ours too,especially as it was completely clear at that stage there would be no recovery. No, he hadn't got an advanced directive,as,when he was organising power of attorney for his finances,there were no such legal documents,and,by the time there was,he had been diagnosed with the vascular dementia,making this opportunity difficult to get signed off by a doctor. The guilt,I think ,is part of the natural stages of grief,but it still concerns me that we possibly could have done more.If you are thrown into situations you have never been in before,along with the upset and distress,it's almost too difficult to think straight and know your rights or who to talk to.We didn't have the time or opportunities we should have had at the time. Then afterwards,(prognosis being very short), he continued for a further 18 months in a state that we could never be sure if 1: he knew who we were 2: If he felt pain,and how much( he showed signs in screwing up his face,but weren't ever sure) 3: If he had some awareness,how much? It was sometimes nice to 'think ' we saw a response or reaction to our visits/music etc but on the flip side,if he did have some awareness,we hope he didn't understand his situation and wonder why we hadn't done anything. We had no way of telling,which was torturous,let alone the condition he had been left in because of the decision to have the PEG fitted. I do have some hope that his story being told to the right people will lead to serious discussion and debate and awareness for others.
I am sorry for your loss,but pleased you gave your story. I have heard similar stories where family would like to keep their loved one 'alive' and I think that is a perfectly natural feeling,especially if they are getting a response from loved one,so can see some quality to their life. I am glad you got a proper chance to speak to a consultant and discuss things,this was not our experience.As I have said before,we feel that my Father was treated as a stroke patient foremost(which PEGS are regularly used for) but the dementia should have been a consideration on equal level,if not more.Although he was ' medically stable' (breathing for himself and heart going)and able to leave hospital as far as that was concerned to free up a much needed bed,but no home would take him without the PEG. He had no quality to his life in our opinion and it was clear it wasn't going to change at that point or in the future. Ultimately he was, in our opinion, 'force fed' (as it it well documented,both elderly,and especially dementia patients,lose the feelings of hunger and their ability to digest food efficiently) ,but once fitted,there is no going back. As I say,talking about it,hearing other peoples experiences,we hope to raise awareness and maybe make a small difference in the future.
