Tube feeding in the demented elderly with severe disabilities.
BACKGROUND
Despite the ongoing debate on tube feeding of severely demented patients, the current approach in western countries is to avoid feeding by tube.


OBJECTIVE
To assess the clinical course and outcome of demented elderly patients with severe disabilities, by feeding mode.


METHODS
The study was conducted in a skilled nursing department of a major psychogeriatric hospital in Israel. Eighty-eight patients aged 79 +/- 9 years were followed for 17 months: 62 were fed by nasogastric tube and 26 were orally fed. The groups were compared for background characteristics, underlying medical condition, functional impairment, clinical and nutritional outcomes, and survival.


RESULTS
Tube feeding had no beneficial effect on clinical and nutritional outcomes or on healing preexisting pressure ulcers, compared with oral feeding. Very few patients on tube feeding showed signs of discomfort, partly because of low cognitive function. Survival was significantly higher in the tube-fed patients (P < 0.001), which could be partly explain by the different case mix (i.e., the underlying diseases)


CONCLUSIONS
Tube feeding seems to have no nutritional advantage in severely demented elderly patients. Median survival was longer in tube-fed individuals who had no acute co-morbidity. However, since tube feeding does not add to patient pain and discomfort, it should not be contraindicated when it complies with the values and wishes of patients and their families.
Jaul
Efraim
E
Department of Skilled Geriatric Nursing, Herzog Hospital, Jerusalem, Israel, Affiliated to Hebrew University-Hadassah Medical School, Jerusalem, Israel. jaul@zahav.net.il
Singer
Pierre
P
Calderon-Margalit
Ronit
R
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003704:Dementia / Q000401:mortality / Q000451:nursing* / Q000503:physiopathology; D006233:Persons with Disabilities; D004750:Enteral Nutrition / Q000379:methods / Q000451:nursing; D005248:Feeding Methods; D005260:Female; D015577:Geriatric Assessment; D005851:Geriatric Nursing / Q000379:methods; D006778:Hospitals, Psychiatric; D006801:Humans; D007441:Intubation, Gastrointestinal; D007557:Israel; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D016134:Organizational Policy; D010043:Outcome and Process Assessment, Health Care; D016019:Survival Analysis