Impact of Enteral Tube Feeding Compared to Oral Hand Feeding on Mortality, Pneumonia

Incidence, Hospitalization and Quality of Life in Patients with Advanced Dementia: A Review
Mackenzie Heisler, Vivian Huh, Ama Kyeremateng, Emily Lim, Briana Walsh, Joachim Sackey, Ph.D., Julie O’Sullivan Maillet, Ph.D., RDN
School of Health Professions, Department of Clinical and Preventive Nutrition Sciences at Rutgers University

BACKGROUND AND STUDY OBJECTIVE RESULTS

• The prevalence of dementia is on the rise, and the accompanying cognitive and physical complications raise questions on its impact Participation Quality of Life
on nutritional intake, and subsequently, the optimal feeding route for individuals with advanced dementia.
Enteral Tube Feeding Oral Hand Feeding Total
• The study objective is to assess the effectiveness of enteral tube feeding in comparison to oral hand feeding in improving survival,
hospitalization, pneumonia incidence, and quality of life in adults 60 years and older with advanced dementia. Chou, 2020 130 39 169

Ticinesi, 2016 54 130 184

METHODS Cintra, 2014 31 36 67
• The literary review was conducted by the graduate students primarily using four online databases: PubMed, CINAHL, Cochrane
Jaul, 2006 26 62 88
Library and Academic Search Premier. Probed articles were published between January 2006 - June 2020.

• Key search terms included: (advanced dementia) AND (enteral nutrition OR nutritional support OR percutaneous endoscopic Mortality Rate
gastrostomy OR artificial feeding OR tube feeding OR stomach tube OR forced feeding) AND (hand feeding OR oral feeding OR
dysphagia diet OR assisted feeding) AND (mortality OR survival OR clinical prognosis OR adverse effects OR clinical course OR
pneumonia OR hospitalization OR quality of life).

Demographics Setting Health Size Dropout

Inclusion
Humans ≥ 60 YO, all
genders, ≥ 70% with
All countries/continents, health
care settings (nursing homes,
Activities of daily living
(ADL) dysfunction
n ≥ 10 per
population
<20%
SUMMARY
dementia long term care), (feeding assistance), poor or study
residential homes & communities nutritional intake group • Three articles were prospective observational cohort studies and 1 was a retrospective cohort
study. As studies not randomized, study populations may differ.

• Patients with dementia that were able to self-feed, had no indicated caregiver/aide, or no ADL dysfunction were excluded. • Half of the studies reported significantly increased rates of mortality in groups of advanced
dementia patients fed via enteral tube feeding.

RESULTS • One study reported a similar nonsignificant increase in mortality rates in those fed via oral
hand route.

PRISMA Flow Diagram • Half of the studies indicated a nonsignificant increase in hospitalization frequency for those
Pneumonia Incidence fed via enteral tube feeding.

• One study reported an increased risk of pneumonia in patients fed via nasogastric tube.
71 Records identified 3 Additional records identified through
Identification

through database searching other sources • One article reported significantly increased complaints of pain and discomfort from patients
fed via oral hand feeding, with indications that that severity of dementia may have
contributed.4

LIMITATIONS
19 Records after duplicates removed • All 4 articles were international studies.
• Lack of direct analysis of quality of life.
• Three articles had disproportionate sample size.
• Three articles did not specify method of oral feeding.
Screening

46 Records excluded, with reasons • Two articles had possible selection bias.
55 Records screened by abstract
- 33 Research article design/type
- 10 Not relevant Hospitalization/Readmission Rate
CONCLUSIONS
- 2 Not written in English
Concerning clinical outcomes and mortality, these findings suggest no
- 1 Withdrawn from publication
significant advantage to using enteral tube feeding options in older patients with advanced
dementia. Thus, the healthcare professional should place primary emphasis on the
patient’s advance directives and provide the primary caregiver a thorough review
Eligibility

5 Full-text articles excluded, with of feeding options.

9 Full-text articles assessed for reasons
eligibility REFERENCES
- 3 Research article design/type
- 1 Majority of study population 1. Chou, H., Tsou, M. & Hwang, L. Nasogastric tube feeding versus assisted hand feeding in-
without dementia home healthcare older adults with severe dementia in Taiwan: a prognosis comparison. BMC
- 1 Written by the same author Geriatr 20, 60 (2020).
2. Ticinesi A, Nouvenne A, Lauretani F, et al. Survival in older adults with dementia and eating
4 Studies included in qualitative problems: To PEG or not to PEG? Clinical Nutr. 2016;35(6):1512-1516.
Included

synthesis Chou, 2020 – Hospitalization Duration (p=0.396) 3. Cintra, M.T.G., de Rezende, N.A., de Moraes, E.N. et al. A comparison of survival,
pneumonia, and hospitalization in patients with advanced dementia and dysphagia receiving
Enteral Tube Feeding Oral Hand Feeding
- 3 Prospective cohort studies either oral or enteral nutrition. J Nutr Health Aging 18, 894–899 (2014).
- 1 Retrospective cohort study Hospitalization 4. Jaul E, Singer P, Calderon-Margalit R. Tube feeding in the demented elderly with severe
17.8 ± 22.4 days 14.2 ± 26.4 days
Duration disabilities. Isr Med Assoc J. 2006;8(12):870‐874.