Jacqueline K. Yuen, MD, Division of Geriatrics, LKS Faculty of Medicine, The University of Hong Kong, Department of Medicine, 4/F Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China. E-mail:
J Nutr Health Aging. 2023;27(6):432-437. doi: 10.1007/s12603-023-1926-9.
Tube feeding is prevalent among patients with advanced dementia despite empirical data that suggest its lack of benefit. To provide an alternative to tube feeding for end-of-life patients, a careful hand feeding program was launched in a Hong Kong geriatric convalescent hospital in February 2017. We aim to compare the rates of feeding tube insertion before and after program implementation and determine risk factors for feeding tube insertion. For patients on careful hand feeding, we evaluated their sustainability on oral feeding and the rates of hospital readmissions compared with tube feeding patients over the next 12 months.
Retrospective cohort study.
Advanced dementia patients ≥60 years with indication for tube feeding due to feeding problems admitted from January 2015-June 2019.
Data was collected on demographic and clinical variables, initial feeding mode (careful hand feeding vs. tube feeding), subsequent feeding mode changes, and hospital admissions over the next 12 months. Rates of feeding tube insertion, sustainability on oral feeding, and hospital readmissions were compared using Chi-square test. Risk factors for feeding tube insertion were assessed using logistic regression models.
Among 616 advanced dementia patients admitted with feeding problems, feeding tube insertion rate declined significantly after careful hand feeding program implementation (72% vs 51% p<.001). Independent risk factors for feeding tube insertion were admission prior to program implementation, presence of dysphagia alone, dysphagia combined with poor intake, and lack of advance care planning. Among patients on careful hand feeding, 91% were sustained on oral feeding over the next twelve months and did not differ significantly before or after careful hand feeding program implementation (p=.67). There was no significant difference in hospital readmission rates between careful hand feeding patients and tube feeding patients before (83% vs 86%, p=.55) and after careful hand feeding program implementation (87% vs 85%, p=.63).
A hospital careful hand feeding program significantly reduced the feeding tube insertion rate among advanced dementia patients with feeding problems. The vast majority of patients on careful hand feeding were sustained on oral feeding over the next 12 months but their rate of hospital readmissions remained similarly high after program implementation.
尽管有经验数据表明管饲对晚期痴呆症患者并无益处，但管饲在这类患者中仍很普遍。为了为终末期患者提供管饲的替代方案，一家位于香港的老年疗养院于 2017 年 2 月启动了一项精心的手部喂养计划。我们旨在比较该计划实施前后的置管率，并确定置管的危险因素。对于接受精心手部喂养的患者，我们评估了他们在接下来 12 个月内继续经口喂养的可持续性，并与接受管饲的患者的住院再入院率进行了比较。
回顾性队列研究。
2015 年 1 月至 2019 年 6 月期间因进食问题而需要管饲的≥60 岁的晚期痴呆症患者，有置管指征。
收集人口统计学和临床变量、初始喂养方式（精心手部喂养与管饲）、随后的喂养方式变化以及接下来 12 个月的住院情况。使用卡方检验比较置管率、经口喂养的可持续性和住院再入院率。使用逻辑回归模型评估置管的危险因素。
在 616 名因进食问题入院的晚期痴呆症患者中，精心手部喂养计划实施后，置管率显著下降（72% vs. 51%，p<.001）。置管的独立危险因素包括在计划实施前入院、存在单纯吞咽困难、吞咽困难伴摄食不良以及缺乏预先护理计划。在接受精心手部喂养的患者中，91%的患者在接下来的 12 个月内持续经口喂养，在实施精心手部喂养计划前后无显著差异（p=.67）。在实施精心手部喂养计划前后，精心手部喂养患者与管饲患者的住院再入院率无显著差异（83% vs. 86%，p=.55；87% vs. 85%，p=.63）。
医院精心的手部喂养计划显著降低了有进食问题的晚期痴呆症患者的置管率。在接下来的 12 个月中，接受精心手部喂养的绝大多数患者仍可经口喂养，但计划实施后，他们的住院再入院率仍然很高。
