Comparing Outcomes of Nasogastric Tube Feeding and Careful Hand Feeding in Elderly with Dementia

Abstract Description

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Authors (including presenting author) :

Lam MK

Affiliation :

Department of Speech Therapy, Pok Oi Hospital

Introduction :

Whether to have tube feeding when dysphagia arises has been a significant and controversial issue to elderly with dementia. Findings on outcomes of tube feeding were varied from the literature. Better understanding on the outcomes of nasogastric tube (NGT) feeding and careful hand feeding (CHF) can facilitate decision-making process.

Objectives :

Investigates i) mortality rate, ii) incidence of aspiration pneumonia, and iii) hospitalization rate and reasons between the two modes of feeding in dementia elderly with dysphagia.

Methodology :

This is a retrospective cohort study. Patients who had consulted ST during their hospital stay from May to Sept 2016 in POH and from Aug to Oct 2016 in TMH were identified. For those with aged 65+, having dementia and moderate-to-severe/ severe dysphagia were recruited. They received either NGT feeding or CHF. Medical data of one year from the date of decision on mode of feeding were retrieved through the CMS.

Result & Outcome :

Sixty-five elderly with dementia were included (n=40, NGT group; n=25, CHF group), with mean age 85.2±7.3 years. Mantel-Cox log-rank test for equality of survival distributions between the two groups on mortality found no statistical significance at 1-year time (55% NGT vs 60% CHF, p=.879). Pneumonia was the most common cause of death. No statistical significance was found on the incidence of aspiration pneumonia using the Kaplan Meier analysis (10% NGT vs 12% CHF, p=.944). Again, no statistical significance was found on at least one episode of hospitalization after mode of feeding decided from the Kaplan Meier analysis (67.5% NGT vs 76% CHF, p=.730). Hospitalization reasons were categorized into 12 categories. Pneumonia was the most common admission reason in both feeding groups (38.3% NGT & 44.7% CHF). For elderly with dementia and dysphagia, no significant difference on mortality, incidence of aspiration pneumonia and hospitalization rate between the two feeding groups. The decision on mode of feeding should be shared between the healthcare professionals and patient’s family. Not only medical condition and general prognosis, but also patient’s prior wishes and their best interests should be considered.