While a healthy, balanced diet improves quality of life, people suffering from common symptoms of advanced dementia often have a weak swallow or lose the ability to swallow safely, especially toward the end of life. For healthcare providers, inserting feeding tubes appeared to be the best option to reduce the risk of aspiration pneumonia and improve the survival of hospitalized patients.
But a new study published in the September issue of JAMDA reveals there is no difference in survival between nasogastric tube feeding (NGF) and careful hand feeding (CHF). In fact, NGF is associated with a higher pneumonia risk for patients with both dysphagia and behavioral feeding problems.
The authors compared the effect of NGF and CHF on survival and pneumonia risk using the Kaplan Meier survival analysis and Cox proportional hazards models. They discovered that NGF wasn’t a significant predictor of survival and that pneumonia rates were lower in the CHF group. They also determined that NGF was associated with increased pneumonia risk for patients with both dysphagia and behavioral feeding problems, but not in patients with feeding problems alone.
The study can serve as a guide for clinicians, family, institutional caregivers and hospitals involved in caring for patients as increased feeding problems accompany advanced dementia. The decision to insert feeding tubes is influenced by myriad factors, including local laws, cultural values and institutional practices. According to the authors, the study helps to strengthen the evidence for CHF, particularly for places where NGF is the predominant mode of long-term feeding of dementia patients. It also provides evidence to support CHF practices in hospitals and nursing homes — not only for quality of life considerations, but the potential to reduce pneumonia risk in this population.