Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2020 Feb 14;20(1):60.
doi: 10.1186/s12877-020-1464-9.

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

Hsiao-Hui Chou  1 , Meng-Ting Tsou  1 , Lee-Ching Hwang  2   3
Affiliations
Comparative Study

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

Hsiao-Hui Chou et al. BMC Geriatr. .

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.

Keywords: Dementia; Hand feeding; Home healthcare; Nasogastric tube; Older adults; Pneumonia; Tube feeding.

PubMed Disclaimer

Conflict of interest statement

There are no potential conflicts of interest with respect to the research, and authorship of this article.

References

    1. Prince MJ. World Alzheimer report 2015: the global impact of dementia: an analysis of prevalence, incidence, cost and trends: Alzheimer's disease international; 2015.
    1. Chen T-F, Chiu M-J, Tang L-Y, Chiu Y-H, Chang S-F, Su C-L, et al. Institution type-dependent high prevalence of dementia in long-term care units. Neuroepidemiology. 2007;28(3):142–149. doi: 10.1159/000102142. - DOI - PubMed
    1. Chen PJ, Liang FW, Ho CH, Cheng SY, Chen YC, Chen YH, et al. Association between palliative care and life-sustaining treatments for patients with dementia: a nationwide 5-year cohort study. Palliat Med. 2018;32(3):622–630. doi: 10.1177/0269216317751334. - DOI - PubMed
    1. Nasogastric tube feeding prevalence in Taiwan. National health insurance Administration Ministry of Health and Welfare in Taiwan. 2017.
    1. Lin LC, Wu SC, Chen HS, Wang TG, Chen MY. Prevalence of impaired swallowing in institutionalized older people in Taiwan. J Am Geriatr Soc. 2002;50(6):1118–1123. doi: 10.1046/j.1532-5415.2002.50270.x. - DOI - PubMed

Publication types

MeSH terms