Tube feeding risks for dementia patient care
Advanced dementia patients initiated on careful hand feeding had a 40% lower risk of pneumonia compared with those on nasogastric tube feeding, according to a collaborative study led by researchers from the Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine at The University of Hong Kong. The findings have been published online in the Journal of Post-Acute and Long-Term Care Medicine. This study suggests a reevaluation of tube feeding for people with advanced dementia, which is currently a widespread practice in Hong Kong.
Difficulty with eating and swallowing are common in patients with advanced dementia and can indicate progression of the disease towards the end of life. Patients with feeding problems such as poor oral intake and dysphagia are often initiated on tube feeding. The putative value of feeding tubes are a reduced risk of aspiration pneumonia and improved survival, benefits which have not been shown in previous observational studies conducted overseas.
In recent years, some geriatric wards in Hong Kong have begun to offer careful hand feeding as an alternative to tube feeding to promote comfort and quality of life in end-of-life patients with feeding problems. This research represents the first study in Hong Kong conducted on hospitalised patients with advanced dementia with feeding problems, finding that patients initiated on careful hand feeding had a significantly lower risk of pneumonia compared with those on nasogastric tube feeding.
Contrary to conventional wisdom, the study provides evidence that nasogastric tube feeding does not confer relative survival benefits in patients with advanced dementia. Instead, nasogastric tube feeding is associated with an increased risk of pneumonia compared with careful hand feeding and may even lead to higher aspiration risk with through impairment of the lower esophageal sphincter, desensitisation of the pharyngoglottal reflex, and reflux of gastric contents into the pharynx.
“As the practice of tube feeding in advanced dementia patients remains prevalent in Hong Kong and many parts of the world, this research highlights the need for further education of the public and healthcare providers to improve evidence-based practice around tube feeding decisions in dementia patients,” said Dr Jacqueline Yuen, Clinical Assistant Professor at the School of Clinical Medicine at HKUMed.