A CQI feeding program for advanced dementia and End of Life (EoL) patients in the extended care setting

Abstract Description

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Authors (including presenting author) :

Lai WSW(1), Woo LC(1), Sit CW(1), Ho YSC(1), Lam CM(1), Lau SL(1), Ma KMC(1), Fong PY(1), Wong LKS(1), Tsang KW(1), Fung MK(1), Lee SCP (1), Yuen YHH(2), Au LFV(3), Yuk KLD(1), Hui E(1)

Affiliation :

(1) Medical and Geriatric Department, Shatin Hospital, (2) Speech Therapy Department, Shatin Hospital, (3) Dietetic Department, Shatin Hospital

Introduction :

Feeding problem is not uncommon especially for advanced dementia patients in the later phase of life. Retrospective case note reviewed that dysphagia and poor feeding accounted for 39% in total distressing symptoms of EoL patients. Usual practice of inserting naso-gastric tube for patients with dementia who refused eating was common in order to maintain their hydration and nutritional status. To prevent patients from pulling out of the tubes, patients might also require putting on hands restraint. In order to enhance quality of care for this group of patients, a ‘Dementia Feeding Program’ was piloted in June 2016 using patient-centred approach to assess individual food preferences and feeding behaviors to promote the process of food enjoyment.

Objectives :

1. To promote comfort and optimize eating experience for patients with advanced dementia and those under EoL care program by using careful hand feeding technique in order to enhance the quality of patients and their families. 2. To respect the care preference of maintaining oral feeding documented in Advance Care Planning (ACP). 3. To roll out this program to those patients with the above needs in other Medical & Geriatric wards

Methodology :

1. A multidisciplinary team approach including doctor, nurses, speech therapist and dietitian were involved; staff education on swallowing safety and feeding technique, e.g. oral stimulation exercise; a variety choice of traditional snacks/food was stocked in ward to promote food enjoyment and to stimulate their eating experience. 2. Patients’ premorbid individual food preferences, eating behaviors, eating habits were assessed by using ‘Dementia Passport’; family/careres were encouraged to feed patients by offering flexible visiting hours; 3. Oral hygiene, oral stimulation exercise or facial massage were performed before and during feeding to stimulate swallowing action; ample time for feeding was allowed and warm food temperature was maintained during feeding

Result & Outcome :

From Jun 2016 to mid-Dec 2018, 114 patients (F: 77, M: 37) were recruited into this program. Average age was 90.7 (F: 91.4; M: 89.2). There were 114 patients with total 135 patient admissions (EoL: 56; Advanced Dementia: 66; Others: 13) requested this patient-centered feeding program. 18 patients had two or more hospital admissions. Upon their discharge or dead: 1. 96.3% (130/135) of patients could successfully have maintained oral feeding. Only 5 patients needed tube feeding. 2. 96.4% (54/56) of EoL patients' admissions could maintain oral feeding, and all of their choice of feeding was being respected. 3. 95.5% (63/66) of Advanced Demented patients' admission with feeding problem could maintain oral feeding. 4. Satisfaction survey (from 06/16-06/18) done by the dietitian on this program showed that > 90 % of caregivers satisfied with the program and agreed that patients’ appetite improved when they were able to eat their favorite traditional food. 5. This patient-centered care program was rolled out to other 2 medical wards since Aug till mid-Dec 2018. 12 patients (F: 7; M: 5), with 13 hospital admissions, requested this feeding program. Average age was 88.1 (F: 92.9; M: 81.4). All their patients could have their care wish for oral feeding maintained and respected.