Nasogastric tube feeding versus assisted hand feeding in-home health care older adults with severe dementia in Taiwan: a prognosis comparison
Abstract Backgrounds/Objectives All 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 elderly home care residents is increasing, yet the tube feeding’s benefit in these groups is still unknown. We compared the clinical prognosis and mortality rate of demented elderly patients who received nasogastric tube feeding (NGF) or assisted hand feeding (AHF).Methods This retrospective observational study enrolled 202 participants aged over 60 years in the setting of home health care between January 1 and December 31, 2017. All subjects with documented severe dementia suffered from difficulty in oral intake and needed either AHF or NGF. Data were collected from both groups to analyze pneumonia, hospitalization, and mortality rates.Results A total of 202 subjects (61 males and 141 females, aged 85.7 ± 7.7 years) were analyzed. Of note, 61 had AHF, and 141 had NGF. Most subjects were in a bed-ridden status, with 83.7% on Eastern Cooperative Oncology Group (ECOG) scale 4 and 66.3% with a Barthel index less than score 10. Pneumonia risk was higher in NGF (46.8%) than in AHF (24.6%, p = 0.0031). Despite adjusting for multiple factors in the regression model, a higher incidence of pneumonia risk was still observed in the NGF group (aOR = 2.15, 95% CI 1.01–4.56). The one-year mortality rates in AHF and NGF were 8.3% and 14.2%, respectively, and no significant difference was observed after adjustment with logistic regression (aOR = 1.20, 95% CI 0.37–3.90). No significant differences were observed in hospitalization rate and duration.Conclusions For in-home health care elderly demented patients, NGF is associated with a significantly higher pneumonia rate compared with AHF. Additionally, neither the mortality nor the hospitalization rates decreased in the NGF group. Therefore, on the basis of these findings, we should question the benefits of NGF for in-home health care elderly demented subjects. Continued careful hand feeding could be an alternative to tube feeding in severe dementia. Furthermore, we should consider the quality of life and make individualized decisions before deciding to use tube feeding.