Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
Department of Medicine, Mackay Medical College, Taipei, Taiwan.
BMC Geriatr. 2020 Feb 14;20(1):60. doi: 10.1186/s12877-020-1464-9.
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).
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.
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.
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.
所有严重痴呆症患者都应接受精心喂养。然而，在某些情况下，患者会被放置喂养管。在台湾，痴呆症老年居家护理居民的置管率正在上升；然而，这种人群的管饲喂养的益处仍不清楚。我们比较了接受鼻胃管喂养（NGF）或辅助手动喂养（AHF）的严重痴呆老年患者的临床预后和死亡率。
对 2017 年 1 月 1 日至 12 月 31 日的家庭医疗系统数据进行了回顾性纵向分析，共纳入 169 名 60 岁以上的参与者。所有严重痴呆且完全功能依赖的患者均存在经口摄入困难，需要 AHF 或 NGF。从两组中收集数据，以分析肺炎、住院和死亡率。
共分析了 169 名受试者（56 名男性和 113 名女性，年龄 85.9±7.5 岁）。39 名患者需要 AHF，130 名患者需要 NGF。所有患者均卧床不起；129 名（76%）患者的巴氏指数<10。NGF 组（48%）肺炎风险高于 AHF 组（26%，p=0.015）。在回归模型中调整多个因素后，NGF 组肺炎风险与 AHF 组无显著差异。AHF 和 NGF 组的 1 年死亡率分别为 8%和 15%，经逻辑回归调整后无显著差异（aOR=2.38；95%CI，0.58-9.70）。住院率和住院时间无显著差异。
对于需要家庭医疗的老年痴呆症患者，NGF 与 AHF 相比，肺炎风险无显著降低。此外，死亡率和住院率均未随 NGF 降低。相反，NGF 组肺炎风险增加的趋势不显著。因此，在需要家庭医疗的严重痴呆症老年患者中，NGF 的益处值得商榷。在严重痴呆症患者中，继续精心喂养可能是 NG 喂养的替代方法。此外，还需要对家庭医疗进行大规模研究来支持这些结果。
