Enteral tube feeding in older people with advanced dementia: findings from a Cochrane systematic review.
OBJECTIVE
Enteral tube feeding for people with advanced dementia who have difficulty swallowing and poor nutritional intake is common. Potential benefits or harms of this practice are unclear and the authors aimed to evaluate the outcomes of this intervention.


METHODS
A full literature review was undertaken in April 2008. Randomized controlled trials (RCTs), controlled clinical trials, controlled before and after studies, interrupted time series studies and controlled observational studies that evaluated the effectiveness of enteral feeding via a nasogastric tube or via a tube passed by percutaneous endoscopic gastrostomy were selected. The study population comprised adults aged 50 and over with a diagnosis of advanced primary degenerative dementia who had poor nutritional intake and/or developed problems with eating and swallowing. The primary outcomes were survival and quality of life (QOL).


RESULTS
No RCTs were identified. Seven observational controlled studies were found; six assessed mortality. There was no evidence of increased survival in people with dementia receiving enteral tube feeding. The other study assessed nutritional outcomes. None of the studies examined the effect on QOL and there was no evidence of benefit in terms of nutritional status or the prevalence of pressure ulcers.


CONCLUSIONS
There is insufficient evidence to suggest that enteral tube feeding is beneficial in people with advanced dementia. Data is lacking on the adverse effects of this intervention.
Department of Mental Health Sciences, Royal Free and University Cpollege Medical School, London. b.candy@medsch.ucl.ac.uk
Bridget
B
Candy
Elizabeth L
EL
Sampson
Louise
L
Jones
D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D003704:Dementia / Q000150:complications*; D004750:Enteral Nutrition / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005773:Gastroscopy; D005774:Gastrostomy; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012720:Severity of Illness Index; D016896:Treatment Outcome