Abstract
To the Editor.— Your consultant's answers to the question on Feeding in the Elderly 1 are vague. I would like to add a few important points. The decision to prolong life or not is difficult, and, unfortunately, there are no clear legal guidelines that physicians can depend on. Nasogastric feeding using soft, thin tubes 2 does not cause physical discomfort. However, for ease of administration and long-term maintenance, a feeding gastrostomy or jejunostomy is necessary (and not gastroenterostomy, as mentioned in the answer). The former is ideal for uncooperative patients who frequently pull out tubes, but leakage of gastric contents with skin excoriation, aspiration, or tube migration is a serious problem. A feeding jejunostomy, performed with meticulous surgical detail, is most ideal for long-term enteral nutrition. Continuous feeding is unphysiological and limits patients' activity. Intermittent (or bolus) feedings via a jejunostomy are not well tolerated and can be used
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