Tube feeding in the demented elderly with severe disabilities.
ABSTRACT Despite the ongoing debate on tube feeding of severely demented patients, the current approach in western countries is to avoid feeding by tube.
To assess the clinical course and outcome of demented elderly patients with severe disabilities, by feeding mode.
The study was conducted in a skilled nursing department of a major psychogeriatric hospital in Israel. Eighty-eight patients aged 79 +/- 9 years were followed for 17 months: 62 were fed by nasogastric tube and 26 were orally fed. The groups were compared for background characteristics, underlying medical condition, functional impairment, clinical and nutritional outcomes, and survival.
Tube feeding had no beneficial effect on clinical and nutritional outcomes or on healing preexisting pressure ulcers, compared with oral feeding. Very few patients on tube feeding showed signs of discomfort, partly because of low cognitive function. Survival was significantly higher in the tube-fed patients (P < 0.001), which could be partly explain by the different case mix (i.e., the underlying diseases)
Tube feeding seems to have no nutritional advantage in severely demented elderly patients. Median survival was longer in tube-fed individuals who had no acute co-morbidity. However, since tube feeding does not add to patient pain and discomfort, it should not be contraindicated when it complies with the values and wishes of patients and their families.
Article: Palliative care in dementia[Show abstract] [Hide abstract]
ABSTRACT: Objectives To analyze the current literature on the various aspects of palliative care in advanced dementia (AD).Material and methodsA narrative review focused on the literature available regarding the final stages of dementia: prognosis, decision-making, assessment of patient needs, support/alleviation of symptoms and the integration of palliative care into the comprehensive care of AD.ResultsAD is a terminal disease associated with extensive suffering and having to make difficult decisions in its most severe stages. Estimating prognosis is difficult, which may explain why most patients are not included in palliative care programs. The decision-making process is characterized by uncertainty due to the lack of scientific evidence backing the efficacy of treatments and the need to reconcile conflictive points of view, as well as due to the difficulty of understanding patient wishes. Caring for these patients is difficult; for them, non-verbal communication is essential and careful attention to the presence of symptoms is required. It is also necessary to take into consideration the suffering of caregivers. The few studies that have developed specific tools for guiding the final phase of life in AD and the specific measurements of outcomes have demonstrated what can be achieved and the significant work ahead.Conclusions Further research on end-of-life care for persons with dementia is needed in order to develop interventions that address the particular challenges of dying with this disease and to be able to improve the end-of-life care provided to these patients in the environments where the majority of them live and die.European geriatric medicine 04/2012; 3(2):131–140. DOI:10.1016/j.eurger.2012.01.015 · 0.55 Impact Factor
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ABSTRACT: This study aimed to evaluate the survival rate, pneumonia incidence, and hospital admissions among elderly patients with advanced dementia and to compare these outcomes between patients receiving enteral and oral nutrition. An observational, prospective, non-randomized, and unblinded study, with a minimum follow up of 6 months. Inpatient wards as well as ambulatory and emergency units run by a Brazilian university. Dysphagic elderly patients aged ≥60 years with advanced dementia (classified as at least 7A according to the Functional Assessment Staging [FAST]). Both patients with gastrostomies and nasogastric feeding tubes were included in the alternative feeding group. Following informed consent, a complete clinical examination was performed upon recruitment, and the primary caregiver was interviewed. Data concerning the major outcomes described above, as well as other demographic and clinical information, were recorded at admission and during follow-up phone calls. Survival analysis was performed using a Kaplan-Meier curve and a stepwise Cox regression analysis. Sixty-seven elderly patients were recruited: 36 (53,7%) for oral feeding and 31 for alternative feeding (n=28 nasogastric tube). Of these, 57 (85.1%) were classified as at least FAST 7C. They were, on average, 84.79 years old, mostly women (85.1%), and with a low level of education (2.9 years). Mortality at 3 months was 11.1% among the oral feeding group and 41.9% among the alternative feeding group (p=0.004). At 6 months, the mortality rate increased to 27.8% and 58.1%, respectively (p=0.012). The following variables persisted in the regression model at the end of the analysis: feeding route (p = .018; RR = 2.33; CI: 1.158-4.667), duration of dementia (p = .014; RR = .88; CI: .786-.974) and number of pressure ulcers (p = .007; RR = 1.250; CI: 1.063-1.470). A higher incidence of aspiration pneumonia was observed in the alternative feeding group (p=0.006), but no difference in the number of hospital admissions was detected between the groups (p=0.365). The use of alternative feeding, along with the number of pressure ulcers were associated with an increased risk of death in elderly patients with advanced dementia. A higher incidence of aspiration pneumonia was also observed in the alternative feeding group. The number of hospital admissions was not different between the feeding routes.The Journal of Nutrition Health and Aging 10/2014; 18(10):894-9. DOI:10.1007/s12603-014-0487-3 · 2.66 Impact Factor
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ABSTRACT: The present article aims to evaluate the outcomes of enteral nutrition for people with advanced dementia. A systematic review was conducted by searching The Cochrane Library, MEDLINE, EMBASE, PROQUEST and LILACS for articles that were published from 2008 to 2013. Prospective and retrospective studies involving a control group were searched. Data were independently extracted and assessed by one reviewer and checked by a second. Searched outcomes included survival, clinical and nutritional parameters and complications. In total, nine controlled studies were identified from several parts of the world: Israel, Italy, Japan, the United States and Brazil. Most of the studies did not report any outcome of harm with enteral nutrition use in dementia patients compared with patients without dementia. A study with a higher follow-up period demonstrated improvements in albumin, weight and chronic inflammation parameters. It is not possible to affirm that tube feeding is harmful for dementia patients. Thus, an adequate follow-up by a multidisciplinary team may lower complications associated with this therapy and thus improve survival.The Journal of Nutrition Health and Aging 01/2015; 19(2):169-77. DOI:10.1007/s12603-014-0517-1 · 2.66 Impact Factor