Caregiver Preference for Tube Feeding in Community‐Dwelling Persons with Severe Dementia

2020 ◽  
Vol 68 (10) ◽  
pp. 2264-2269
Author(s):  
Zafirah Zain ◽  
Hazirah Mohamad ◽  
Dennis Seow ◽  
Allyn Hum Yin Mei ◽  
John Carson Allen ◽  
...  
Keyword(s):  
Tube Feeding ◽  
Community Dwelling ◽  
Severe Dementia ◽  
Caregiver Preference

scholarly journals Singaporean Dementia Caregivers’ Preference for Care Recipients’ Life-Extending Interventions

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 541-541
Author(s):  
Chetna Malhotra ◽  
Hazirah Mohamad ◽  
Truls Østbye ◽  
Kathryn Pollak ◽  
Bharathi Balasundaram ◽  
...  
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Health Care Providers ◽  
End Of Life Care ◽  
Tube Feeding ◽  
Community Dwelling ◽  
Life Care ◽  
Care Providers ◽  
Severe Dementia ◽  
Care Recipients

Abstract Family caregivers of older adults with severe dementia are decisive in use of potentially life-extending interventions for their care recipients. We conducted in-depth interviews with 26 caregivers of community-dwelling older adults with severe dementia in Singapore to assess their preferences for intravenous (IV) antibiotics for a life threatening infection, tube feeding, and cardiopulmonary resuscitation (CPR), and reasons thereof. Most caregivers’ (77%) end-of-life care goal was ‘no life extension’. Yet, 80%, 60% and 45% preferred IV antibiotics, tube feeding and CPR, respectively, as they: 1) perceived letting go by withholding interventions as unethical, 2) felt they had no choice, deferring to health care providers (HCPs), 3) wanted to alleviate suffering, and 4) desired trying minimally invasive (and potentially withdrawable) interventions. There was discordance between caregivers’ end-of-life care goal and preferences for life-extending interventions. HCPs can suggest intervention options that concur with caregivers’ end-of-life care goal, and use a shared decision-making approach. Part of a symposium sponsored by the Aging Among Asians Interest Group.

scholarly journals Enteral tube feeding for people with severe dementia

2021 ◽  
Vol 2021 (8) ◽  
Author(s):  
Nathan Davies ◽  
Yolanda Barrado-Martín ◽  
Victoria Vickerstaff ◽  
Greta Rait ◽  
Akiko Fukui ◽  
...  
Keyword(s):  
Tube Feeding ◽  
Severe Dementia ◽  
Enteral Tube Feeding

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

2020 ◽  
Author(s):  
Hsiao-Hui Chou ◽  
Meng-Ting Tsou ◽  
Lee-Ching Hwang
Keyword(s):  
Nasogastric Tube ◽  
Older Patients ◽  
Tube Feeding ◽  
Mortality Rates ◽  
Home Healthcare ◽  
Severe Dementia ◽  
Clinical Prognosis ◽  
Increased Risk ◽  
Significant Difference ◽  
Nasogastric Tube Feeding

Abstract Backgrounds: 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: This retrospective longitudinal study enrolled 169 participants over 60 years of age in the setting of in-home healthcare between January 1 and December 31, 2017. All subjects with documented 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. Of note, 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 older subjects belonging to the NGF group compared to 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 non-significant 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 home healthcare would be required to support these results.

scholarly journals Nasogastric tube feeding versus assisted hand feeding in-home health care older adults with severe dementia in Taiwan: a prognosis comparison

2019 ◽  
Author(s):  
Hsiao-Hui Chou ◽  
Meng-Ting Tsou ◽  
Lee-Ching Hwang
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Nasogastric Tube ◽  
Eastern Cooperative Oncology Group ◽  
Tube Feeding ◽  
Home Health ◽  
Severe Dementia ◽  
Clinical Prognosis ◽  
Significant Difference ◽  
Nasogastric Tube Feeding

Abstract Backgrounds/Objectives 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 elderly home care residents is increasing, yet the tube feeding’s benefit in these groups is still unknown. We compared the clinical prognosis and mortality rate of demented elderly patients who received nasogastric tube feeding (NGF) or assisted hand feeding (AHF).Methods This retrospective observational study enrolled 202 participants aged over 60 years in the setting of home health care between January 1 and December 31, 2017. All subjects with documented severe dementia suffered from difficulty in oral intake and needed either AHF or NGF. Data were collected from both groups to analyze pneumonia, hospitalization, and mortality rates.Results A total of 202 subjects (61 males and 141 females, aged 85.7 ± 7.7 years) were analyzed. Of note, 61 had AHF, and 141 had NGF. Most subjects were in a bed-ridden status, with 83.7% on Eastern Cooperative Oncology Group (ECOG) scale 4 and 66.3% with a Barthel index less than score 10. Pneumonia risk was higher in NGF (46.8%) than in AHF (24.6%, p = 0.0031). Despite adjusting for multiple factors in the regression model, a higher incidence of pneumonia risk was still observed in the NGF group (aOR = 2.15, 95% CI 1.01–4.56). The one-year mortality rates in AHF and NGF were 8.3% and 14.2%, respectively, and no significant difference was observed after adjustment with logistic regression (aOR = 1.20, 95% CI 0.37–3.90). No significant differences were observed in hospitalization rate and duration.Conclusions For in-home health care elderly demented patients, NGF is associated with a significantly higher pneumonia rate compared with AHF. Additionally, neither the mortality nor the hospitalization rates decreased in the NGF group. Therefore, on the basis of these findings, we should question the benefits of NGF for in-home health care elderly demented subjects. Continued careful hand feeding could be an alternative to tube feeding in severe dementia. Furthermore, we should consider the quality of life and make individualized decisions before deciding to use tube feeding.

Pain management in community-dwelling older adults with moderate-to-severe dementia

2021 ◽  
Vol 27 (3) ◽  
pp. 158-166
Author(s):  
Chiaki Ando ◽  
Yusuke Kanno ◽  
Osamu Uchida ◽  
Emiko Nashiki ◽  
Noriko Kosuge ◽  
...  
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
Home Visiting ◽  
Final Analysis ◽  
Management Training ◽  
Community Dwelling ◽  
Severe Dementia ◽  
Cross Sectional ◽  
Visiting Nurses ◽  
Community Dwelling Older Adults

Background: This study explored visiting nurses' knowledge and beliefs regarding pain management in community-dwelling older adults with moderate-to-severe dementia. Methods: A cross-sectional study design was used to collect data in 2019. A questionnaire was mailed to nursing managers at 1037 home-visiting nursing stations in Japan. Findings: The final analysis included 230 responses. The mean score on the knowledge and belief statements was 14 out of a possible 18, and respondents with more pain management training obtained a higher total score on knowledge than those without such training (p<.001). More than 95% indicated that they needed training on pain management for older adults with dementia. Conclusion: Visiting nurses in Japan require training in pain management for older adults with moderate-to-severe dementia. Despite its usefulness, the current pain management training programme should be improved to enable visiting nurses to manage dementia patients' pain more confidently.

scholarly journals Enteral tube feeding for people with severe dementia

2019 ◽  
Author(s):  
Nathan Davies ◽  
Yolanda Barrado-Martin ◽  
Greta Rait ◽  
Akiko Fukui ◽  
Bridget Candy ◽  
...  
Keyword(s):  
Tube Feeding ◽  
Severe Dementia ◽  
Enteral Tube Feeding

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

2019 ◽  
Author(s):  
Hsiao-Hui Chou ◽  
Meng-Ting Tsou ◽  
Lee-Ching Hwang
Keyword(s):  
Elderly Patients ◽  
Nasogastric Tube ◽  
Large Scale ◽  
Tube Feeding ◽  
Mortality Rates ◽  
Home Healthcare ◽  
Severe Dementia ◽  
Clinical Prognosis ◽  
Significant Difference ◽  
Nasogastric Tube Feeding

Abstract Backgrounds: 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 elderly home care residents is increasing；however, the benefits of tube feeding in this population remain unknown. We compared the clinical prognosis and mortality of elderly patients with severe dementia receiving nasogastric tube feeding (NGF) or assisted hand feeding (AHF). Methods: This retrospective longitudinal study enrolled 169 participants over 60 years of age in the setting of in-home healthcare between January 1 and December 31, 2017. All subjects with documented 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. Of note, 39 required AHF and 130 NGF. All subjects were in a bedridden status；129 (76.3%) showed Barthel index < 10. Pneumonia risk was higher in the NGF group (47.7%) than in the AHF group (25.6%, p = 0.015). After adjusting for multiple factors in the regression model, the risk of pneumonia showed no significant difference in both groups (aOR = 2.20, 95% CI 0.92–5.30). One-year mortality rates in the AHF and NGF groups were 7.7% and 14.6%, 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 elderly 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. However, aORs with the trend of increasing risk of in the NGF group were observed in measured outcomes. Therefore, the benefits of NGF are debatable in elderly 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 home healthcare would be required to support these results.

Sign in / Sign up

Export Citation Format

Share Document