Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison

Abstract Backgrounds: 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；however, the benefits of tube feeding in this population remain unknown. We compared the clinical prognosis and mortality of elderly patients with severe dementia receiving nasogastric tube feeding (NGF) or assisted hand feeding (AHF). Methods: This retrospective longitudinal study enrolled 169 participants over 60 years of age in the setting of in-home healthcare between January 1 and December 31, 2017. All subjects with documented 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. Results: A total of 169 subjects (56 males and 113 females, aged 85.9 ± 7.5 years) were analyzed. Of note, 39 required AHF and 130 NGF. All subjects were in a bedridden status；129 (76.3%) showed Barthel index < 10. Pneumonia risk was higher in the NGF group (47.7%) than in the AHF group (25.6%, p = 0.015). After adjusting for multiple factors in the regression model, the risk of pneumonia showed no significant difference in both groups (aOR = 2.20, 95% CI 0.92–5.30). One-year mortality rates in the AHF and NGF groups were 7.7% and 14.6%, 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. Conclusions: For elderly 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. However, aORs with the trend of increasing risk of in the NGF group were observed in measured outcomes. Therefore, the benefits of NGF are debatable in elderly 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 home healthcare would be required to support these results.

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Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison

10.21203/rs.2.16188/v3 ◽

2020 ◽

Author(s):

Hsiao-Hui Chou ◽

Meng-Ting Tsou ◽

Lee-Ching Hwang

Keyword(s):

Nasogastric Tube ◽

Older Patients ◽

Tube Feeding ◽

Mortality Rates ◽

Home Healthcare ◽

Severe Dementia ◽

Clinical Prognosis ◽

Increased Risk ◽

Significant Difference ◽

Nasogastric Tube Feeding

Abstract Backgrounds: 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 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). Methods: This retrospective longitudinal study enrolled 169 participants over 60 years of age in the setting of in-home healthcare between January 1 and December 31, 2017. All subjects with documented 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. Results: A total of 169 subjects (56 males and 113 females, aged 85.9 ± 7.5 years) were analyzed. Of note, 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 older subjects belonging to the NGF group compared to 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. Conclusions: For 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 non-significant 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 home healthcare would be required to support these results.

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Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison

10.21203/rs.2.16188/v4 ◽

2020 ◽

Author(s):

Hsiao-Hui Chou ◽

Meng-Ting Tsou ◽

Lee-Ching Hwang

Keyword(s):

Nasogastric Tube ◽

Older Patients ◽

Tube Feeding ◽

Mortality Rates ◽

Home Healthcare ◽

Severe Dementia ◽

Clinical Prognosis ◽

Increased Risk ◽

Significant Difference ◽

Nasogastric Tube Feeding

Abstract Background: 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 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). Methods: Data 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. Results: A 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. Conclusions: For 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.

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Nasogastric tube feeding versus assisted hand feeding in-home health care older adults with severe dementia in Taiwan: a prognosis comparison

10.21203/rs.2.16188/v1 ◽

2019 ◽

Author(s):

Hsiao-Hui Chou ◽

Meng-Ting Tsou ◽

Lee-Ching Hwang

Keyword(s):

Health Care ◽

Home Health Care ◽

Nasogastric Tube ◽

Eastern Cooperative Oncology Group ◽

Tube Feeding ◽

Home Health ◽

Severe Dementia ◽

Clinical Prognosis ◽

Significant Difference ◽

Nasogastric Tube Feeding

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.

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