Feeding Tubes Associated with an Increase in Pneumonia for Patients with Advanced Dementia
FOR IMMEDIATE RELEASE
September 20, 2022
Contact: Ellen Mullally
Feeding problems are common in patients with advanced dementia and can indicate progression of the disease toward the end of life. Feeding tubes are commonly inserted because of the perceived benefits of reducing risk of aspiration pneumonia and improving survival. But a study in the September issue of JAMDA says there is no difference in survival between nasogastric tube feeding (NGF) and careful hand feeding (CHF). However, NGF is associated with a higher pneumonia risk, particularly for patients with both dysphagia and behavioral feeding problems.
In Careful Hand Feeding Reduces Pneumonia Risk in Patients with Advanced Dementia with 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 found that NFG wasn’t a significant predictor for 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 behavioral feeding problems alone.
Feeding mode decisions made by consensus between the treating physician and surrogate were influenced by both clinical factors and patient/surrogate preferences. The authors said, “This was evidenced by higher rates of NGF among patients with dysphagia as the primary indication for tube feeding and higher severity of dysphagia.” On the other hand, they noted, higher rates of CHF were found in patients with prior advance care planning and non-hospitalized do not attempt resuscitation (DNAR)/do not resuscitate (DNR) orders.
“Additional studies are needed to examine the potential effects of feeding techniques and food modifications used in CHF on reducing aspiration pneumonia risk,” the authors concluded.
This article was conducted by researchers at the Li Ka Shung Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China; Department of Medicine and Geriatrics, TWGHs Fung You King Hospital, Hong Kong SAR, China: Department of Psychosocial and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; and Department of Speech Therapy, TWGHs Fung You Kin Hospital and Grantham Hospital, Hong Kong SAR, China.
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JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
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AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.