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

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 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/v2 ◽

2019 ◽

Author(s):

Hsiao-Hui Chou ◽

Meng-Ting Tsou ◽

Lee-Ching Hwang

Keyword(s):

Elderly Patients ◽

Nasogastric Tube ◽

Large Scale ◽

Tube Feeding ◽

Mortality Rates ◽

Home Healthcare ◽

Severe Dementia ◽

Clinical Prognosis ◽

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

BMC Geriatrics ◽

10.1186/s12877-020-1464-9 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 3

Author(s):

Hsiao-Hui Chou ◽

Meng-Ting Tsou ◽

Lee-Ching Hwang

Keyword(s):

Older Adults ◽

Nasogastric Tube ◽

Tube Feeding ◽

Home Healthcare ◽

Severe Dementia ◽

Nasogastric Tube Feeding

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Association between teeth loss and nasogastric tube feeding dependency in older adults from Taiwan: a retrospective cohort study

BMC Geriatrics ◽

10.1186/s12877-021-02596-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chun-Chieh Wang ◽

Yu-Yen Chen ◽

Kuo-Chuan Hung ◽

Shang-Jung Wu ◽

Yung-Feng Yen ◽

...

Keyword(s):

Older Adults ◽

National Health ◽

Nasogastric Tube ◽

Tube Feeding ◽

Nasogastric Feeding ◽

Number Of Teeth ◽

Increased Risk ◽

The Mean ◽

Nasogastric Tube Feeding

Abstract Background To examine the association between teeth loss and nasogastric tube feeding dependency in older people. Methods The National Health Interview Survey (NHIS) 2005, 2009, and 2013 in Taiwan. Participants were selected by a multistage stratified sampling method and baseline characteristics, including socioeconomic status and health habits, were obtained by well-trained interviewers. The NHIS was linked with the National Health Insurance research database 2000–2016 and the National Deaths Dataset, which contains all the medical information of ambulatory and inpatient care. Cox regression was used to examine the association between the number of teeth lost and nasogastric tube feeding dependency. Results There were 6165 adults older than 65 years old enrolled in the analysis, with 2959 male (48%) and the mean (SD) age was 73.95(6.46) years old. The mean follow-up duration was 6.5(3.3) years. Regarding the teeth loss categories, 1660 (26.93%), 2123 (34.44%), and 2382 (38.64%) of participants were categorized as having no teeth loss, loss of 1–9 teeth, and loss of 10–28 teeth, respectively. During 39,962 person-years of follow-up, new-onset nasogastric feeding dependency was recognized in 220(13.25%), 256(12.06%), and 461(19.35%) participants who were categorized as having no teeth loss, loss of 1–9 teeth, and loss of 10–28 teeth, respectively. Kaplan-Meier curves demonstrated significant findings (Log-rank P < 0.01). After potential confounders were adjusted, compared with those without teeth loss, older adults who had lost 10–28 teeth had significantly increased risks of occurrence nasogastric feeding dependency (AHR, 1.31; 95% CI, 1.05–1.62; p-value = 0.02). Furthermore, a significant dose-response relation between the number of teeth lost and increased risk of nasogastric feeding was found (p for trend< 0.01). Conclusions Older adults who had lost 10–28 teeth had a significantly increased risk of nasogastric tube feeding dependency. Early identification of the oral disease is crucial for the prevention of the occurrence of teeth loss and the following nutrition problems, which would reduce risk of nasogastric tube feeding dependency.

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Nasogastric Tube Feeding in Older Patients: A Review of Current Practice and Challenges Faced

Current Gerontology and Geriatrics Research ◽

10.1155/2021/6650675 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Devkishan Chauhan ◽

Surabhi Varma ◽

Melanie Dani ◽

Michael B. Fertleman ◽

Louis J. Koizia

Keyword(s):

Enteral Nutrition ◽

Nasogastric Tube ◽

Older Patients ◽

Current Practice ◽

Tube Feeding ◽

Oral Route ◽

Tube Placement ◽

Nasogastric Feeding ◽

National Patient ◽

Nasogastric Tube Feeding

Nasogastric tube feeding is an essential way of delivering enteral nutrition when the oral route is insufficient or unsafe. Malnutrition is recognised as a reversible factor for sarcopenia and frailty. It is therefore crucial that malnutrition is treated in older inpatients who have dysphagia and require enteral nutrition. Despite five National Patient Safety Alerts since 2005, “Never Events” related to nasogastric feeding persist. In addition to placement errors, current practice often leads to delays in feeding, which subsequently result in worse patient outcomes. It is crucial that tube placement is confirmed accurately and in a timely way. Medical advancements in this area have been slow to find a solution which meets this need. In this paper, we provide an updated review on the current use of feeding nasogastric tubes in the older population, the issues associated with confirming correct placement, and innovative solutions for improving safety and outcomes in older patients.

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Obligate Nasal Breathing in an Elderly Woman: Increased Risk of Nasogastric Tube Feeding

Journal of Parenteral and Enteral Nutrition ◽

10.1177/0148607188012005531 ◽

1988 ◽

Vol 12 (5) ◽

pp. 531-532 ◽

Cited By ~ 1

Author(s):

Oscar G. Hernandez ◽

Steve Nelson ◽

Edward F. Haponik ◽

Alfredo Lopez ◽

Warren Summer

Keyword(s):

Nasogastric Tube ◽

Elderly Woman ◽

Tube Feeding ◽

Nasal Breathing ◽

Increased Risk ◽

Nasogastric Tube Feeding

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Case Report: Acute Submandibular Glanditis Caused by Nasogastric Tube Feeding in A Subject with Poorly Controlled Diabetes Mellitus

10.21203/rs.3.rs-1062748/v1 ◽

2021 ◽

Author(s):

Yuichiro Iwamoto ◽

Takatoshi Anno ◽

Katsumasa Koyama ◽

Koichi Tomoda ◽

Tomohiko Kimura ◽

...

Keyword(s):

Diabetes Mellitus ◽

Glycemic Control ◽

Parenteral Nutrition ◽

Submandibular Gland ◽

Nasogastric Tube ◽

Artery Bypass ◽

Tube Feeding ◽

Coronary Intervention ◽

Increased Risk ◽

Nasogastric Tube Feeding

Abstract Background Enteral tube feeding is an effective method of providing nutrients for patients who are unable to meet their nutritional requirements and patients with parenteral nutrition are possible the increased risk of infection. The submandibular gland is one of the salivary glands and some of sialadenitis are caused by obstruction of the salivary outflow tract. Case presentation A 91-year-old woman had parenteral nutrition with nasogastric tube feeding. Her background history was repeated angina and myocardial infarction and performed percutaneous coronary intervention and coronary artery bypass grafting, type 2 diabetes (T2DM), heart failure, atrial fibrillation and sick sinus syndrome and performed, pacemaker placement. She was continued parenteral nutrition with nasogastric tube feeding for 20 days, and suddenly she had high fever and elevated infection markers under poorly glycemic control. We diagnosed her as acute submandibular glanditis. We treated her with antibiotics therapy, extubation, daily massage of the submandibular gland and strict glycemic control, and her neck swelling disappeared about 11 days after such treatment. Conclusions We reported acute submandibular glanditis induced by nasogastric tube feeding under poorly controlled diabetes mellitus. We have to pay attention to glycemic control in subjects under parenteral nutrition with tube feeding management.

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