Nordin Nordiana, Kamaruzzaman Shahrul Bahyah, Chin Ai-Vyrn, Poi Philip J H, Tan Maw Pin
a Division of Geriatric Medicine, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia.
J Nutr Gerontol Geriatr. 2015;34(1):34-49. doi: 10.1080/21551197.2014.998326.
The strong emphasis on feeding in Asian cultures may influence decisions for nasogastric (NG) tube feeding in geriatric inpatients. We evaluated the utility, complications, and opinions of caregivers toward NG tube feeding in an acute geriatric ward in a teaching hospital in Kuala Lumpur. Consecutive patients aged 65 years and older receiving NG tube feeding were included. Sociodemographic, clinical, and laboratory indices were recorded. Opinion on NG tube feeding were evaluated through face-to-face interviews with caregivers, recruited through convenience sampling. Of 432 patients admitted, 96 (22%), age ± standard deviation = 80.8 ± 7.4 years, received NG tube feeding. The complication and mortality rates were 69% and 38%, respectively. Diabetes (odds ratio [95% confidence interval] = 3.34 [1.07, 10.44], aspiration pneumonia (8.15 [2.43, 27.24]), impaired consciousness (3.13 [1.05, 9.36]), and albumin ≤26 g/dl (4.43 [1.46, 13.44]) were independent predictors of mortality. Other relatives were more likely than spouses (23.5 [3.59, 154.2]) and caregivers with tertiary education more likely than those with no formal education ( 18 [1.23, 262.7]) to agree to NG feeding. Sixty-four percent of caregivers felt NG tube feeding was appropriate at the end of life, mostly due to the fear of starvation. NG tube feeding is widely used in our setting, despite high complication and mortality rates, with likely influences from cultural emphasis on feeding.
亚洲文化中对进食的高度重视可能会影响老年住院患者鼻胃管喂养的决策。我们评估了吉隆坡一家教学医院急性老年病房中鼻胃管喂养的实用性、并发症以及护理人员的看法。纳入了连续接受鼻胃管喂养的65岁及以上患者。记录了社会人口统计学、临床和实验室指标。通过对护理人员进行面对面访谈来评估对鼻胃管喂养的看法,护理人员通过便利抽样招募。在432名入院患者中,96名(22%)接受了鼻胃管喂养,年龄±标准差为80.8±7.4岁。并发症发生率和死亡率分别为69%和38%。糖尿病(优势比[95%置信区间]=3.34[1.07,10.44])、吸入性肺炎(8.15[2.43,27.24])、意识障碍(3.13[1.05,9.36])和白蛋白≤26g/dl(4.43[1.46,13.44])是死亡率的独立预测因素。其他亲属比配偶更有可能(23.5[3.59,154.2])同意鼻胃管喂养,接受高等教育的护理人员比未接受正规教育的护理人员更有可能(18[1.23,262.7])同意鼻胃管喂养。64%的护理人员认为在生命末期鼻胃管喂养是合适的,主要是因为担心饥饿。尽管并发症发生率和死亡率很高,但在我们的环境中鼻胃管喂养仍被广泛使用,可能受到文化中对进食重视的影响。