Long-term nasogastric tube feeding in elderly stroke patients--an assessment of nutritional adequacy and attitudes to gastrostomy feeding in Asians.
BACKGROUND
Gastrostomy feeding is superior to long-term nasogastric (NG) feeding in patients with dysphagic stroke, but this practice remains uncommon in Asia. We sought to examine the nutritional adequacy of patients on long term NG feeding and identify barriers to gastrostomy feeding in these patients.


METHODS
A prospective comparison of subjective global assessment (SGA), and anthropometry (mid-arm muscle circumference, MAMC; triceps skinfold thickness, TST) between elderly stroke patients on long-term NG feeding and matched controls was performed. Selected clinicians and carers of patients were interviewed to assess their knowledge and attitudes to gastrostomy feeding.


RESULTS
140 patients (70 NG, 70 oral) were recruited between September 2010 and February 2011. Nutritional status was poorer in the NG compared to the oral group (SGA grade C 38.6% NG vs 0% oral, p<0.001; TST males 10.7 + 3.7 mm NG vs 15.4 + 4.6 mm oral, p<0.001; MAMCmales 187.9 + 40.4 mm NG vs 228.7 + 31.8 mm oral, p<0.001). 45 (64.3%) patients on long-term NG feeding reported complications, mainly consisting of dislodgement (50.5%), aspiration of feed content (8.6%) and trauma from insertion (4.3%). Among 20 clinicians from relevant speciliaties who were interviewed, only 11 (55%) clinicians would routinely recommend a PEG. All neurologists (100%) would recommend a PEG, whilst the response was mixed among non-neurologists. Among carers, lack of information (47.1%) was the commonest reason stated for not choosing a PEG.


CONCLUSIONS
Elderly patients with stroke on long term NG feeding have a poor nutritional status. Lack of recommendation by clinicians appears to be a major barrier to PEG feeding in these patients.
Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. sanjiv@ummc.edu.my
F
F
Zaherah Mohamed Shah
H-S
HS
Suraiya
P J-H
PJ
Poi
K S
KS
Tan
P S M
PS
Lai
K
K
Ramakrishnan
S
S
Mahadeva
D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel / Q000208:ethnology; D003680:Deglutition Disorders / Q000209:etiology*; D004750:Enteral Nutrition / Q000009:adverse effects / Q000523:psychology; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007441:Intubation, Gastrointestinal; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D009462:Neurology; D009752:Nutritional Status; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D020521:Stroke / Q000208:ethnology / Q000503:physiopathology* / Q000523:psychology; D013997:Time Factors; D000078329:Workforce