Abstract
BackgroundAll individuals with severe dementia should be offered careful hand feeding. However, under certain circumstances, people with severe dementia have a feeding tube placed. In Taiwan, tube feeding rate in demented older home care residents is increasing; however, the benefits of tube feeding in this population remain unknown. We compared the clinical prognosis and mortality of older patients with severe dementia receiving nasogastric tube feeding (NGF) or assisted hand feeding (AHF).MethodsData from the in-home healthcare system between January 1 and December 31, 2017 were analyzed to identify 169 participants over 60 years of age in this retrospective longitudinal study. All subjects with severe dementia and complete functional dependence suffered from difficulty in oral intake and required either AHF or NGF. Data were collected from both groups to analyze pneumonia, hospitalization, and mortality rates.ResultsA total of 169 subjects (56 males and 113 females, aged 85.9 ± 7.5 years) were analyzed. 39 required AHF and 130 NGF. All subjects were bedridden; 129 (76%) showed Barthel index < 10. Pneumonia risk was higher in the NGF group (48%) than in the AHF group (26%, p = 0.015). After adjusting for multiple factors in the regression model, the risk of pneumonia was not significantly higher in the NGF group compared with the AHF group. One-year mortality rates in the AHF and NGF groups were 8 and 15%, respectively, and no significant difference was observed after adjustment with logistic regression (aOR = 2.38; 95% CI, 0.58–9.70). There were no significant differences in hospitalization rate and duration.ConclusionsFor older patients with dementia requiring in-home healthcare, NGF is not associated with a significantly lower risk of pneumonia than AHF. Additionally, neither mortality nor hospitalization rates decreased with NGF. On the contrary, a nonsignificant trend of increased risk of pneumonia was observed in NGF group. Therefore, the benefits of NGF are debatable in older patients with severe dementia requiring in-home healthcare. Continued careful hand feeding could be an alternative to NG feeding in patients with severe dementia. Furthermore, large-scale studies on in-home healthcare would be required to support these results.
Highlights
All individuals with severe dementia should be offered careful hand feeding
The Barthel index were significantly different between the assisted hand feeding (AHF) and nasogastric tube feeding (NGF) groups (p < 0.001)
Body mass index (BMI) was significantly higher in the AHF group than in the NGF group (22.7 ± 3.3 and 21.4 ± 3.6, respectively, p = 0.042)
Summary
All individuals with severe dementia should be offered careful hand feeding. Under certain circumstances, people with severe dementia have a feeding tube placed. We compared the clinical prognosis and mortality of older patients with severe dementia receiving nasogastric tube feeding (NGF) or assisted hand feeding (AHF). Dementia is a neurodegenerative disease characterized by a progressive, irreversible, and long-term course. A recent study showed that in Taiwan, the prevalence of dementia was 26.8% in residential houses and 61.8% in assisted living facilities [2]. The National Health Insurance in Taiwan has been reimbursing costs of palliative and home care systems for severe dementia. Owing to the lack of understanding in recognizing progressive and irreversible disease courses, palliative care for severe dementia is not generally accepted as a standard treatment. Palliative care decreases lifesustaining interventions, except for tube feeding [3]
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