Patient‐related factors and mortality associated with nasogastric tube feeding in advanced dementia

Abstract

AbstractBackgroundPrevious studies have not shown survival benefit for long‐term enteral feeding. However, these studies were mostly done in residents of nursing homes, where quality of care may vary. Patients cared for in their own home may have more consistent quality of care. The aim of this study is to explore if NGT feeding prolongs life in community‐dwelling PWSDs and if not, what are other factors that may influence survival in PWSDs. Additionally, we wanted to explore patient‐related factors associated with NGT feeding to better understand the patient profile of PWSDs on NGTMethodCommunity‐dwelling PWSDs with a FAST 6c score or higher, were evaluated and followed‐up for a median duration of 25 months as part of the PISCES study, a prospective longitudinal cohort study.Result215 PWSDs were evaluated, 9.8% (n = 21) had NGT at baseline. Compared to those without NGT, PWSDs on NGT were more likely to have had a stroke (66.7% vs 29.9%, p = 0.001), recent pneumonia (28.6% vs 7.2%,p = 0.001), recent oral antibiotics (57.1% vs 26.8%,p = 0.004) and higher Bedford Alzheimer Nursing‐Severity Scale scores(BANS‐S)(22.4 vs 18.2,P = 0.00). Although PWSDs with NGT had lower physical and verbal behavioural problems(P<0.05), there was increased use of restraints (71.4% vs 44.3%,p = 0.018), pressure sores(28.6% vs 10.8%,p = 0.02) and they had poorer Quality of life(QoL) in late‐stage dementia(QUALID) scores (27.8 vs 22.6,p = 0.006), and no difference in malnourishment rate (19% vs 20%, p = 0.865). PWSDs with NGT had no survival benefit (HR 1.42, 95%CI 0.689‐2.91) despite adjustment for significant comorbidities and dementia severity, however BANS‐S and malnourishment predicted mortalityConclusionWhile NGT use in PWSDs does not predict mortality, poorer BANS‐S scores and malnourishment were associated with higher mortality and this may be because they imply more advanced dementia. PWSDs on NGT had more advanced dementia and comorbidities. Increased use of restraints despite lower behavioural problems could have been pre‐emptive to prevent removal of NGT, while the lower QoL scores might be attributed to more advanced dementia and use of NGT with restraints. These findings can help clinicians and families make informed decisions on tube feeding.