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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In their cohort study of hospitalized patients with advanced dementia, Meier and colleagues¹ found that patients who did not receive gastrostomy tubes had a median survival similar to that of patients who did receive tubes. However, these data cannot support the authors' conclusion that tube feeding "has no measurable influence on survival."

Some patients with end-stage dementia simply stop eating and drinking altogether; obviously, they will die within a week or two without medically administered nutrition and hydration. Among the patients in this study, it is possible that tubes were placed primarily in a subgroup of patients whose oral intake had become insufficient to sustain life, thus prolonging their survival to the observed median of about 6 months. In contrast, it is likely that tubes were not placed in the subgroup of patients who retained some capacity to eat; those patients also survived a median of roughly 6 months. In . . . [Full Text of this Article]

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Using rapid-cycle quality improvement methodology to reduce feeding tubes in patients with advanced dementia: before and after study
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BMJ 2004;329:491-494.
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