Acceptability of Gastrostomy Feeding in Malaysia

doi:10.29461/TGG.201405_9(2).00105
台灣老年醫學暨老年學雜誌, 9(2), 2014

作者/Author： J. Hasif;S. Mahadeva;K.M. Tan;M.P. Tan

頁數/Page： 59-59
出版日期/Publication Date：2014/05
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O04
ACCEPTABILITY OF GASTROSTOMY FEEDING IN MALAYSIA
J. Hasif, S. Mahadeva, K.M. Tan, M.P. Tan
University of Malaya, Malaysia
Objective: This study aims to investigate the perception of
Malaysian health care professionals (HCP) towards gastrostomy
feeding.
Method: We have conducted a survey among HCPs attending a
national conference in Kuala Lumpur. The survey questionnaire
enquired about knowledge, awareness and barriers to
gastrostomy feeding.
Results: 180 participants consisting of 43 doctors, 107
nurses and 30 allied health professionals completed the
questionnaires. 66% agreed PEG feeding should be used
for patients requiring long term enteral feeding (>8 weeks).
Among those who agreed to PEG feeding, 58% said they were
convinced of its benefit, 51% said it was easily available and
48% said it’s a low risk procedure. The remaining 35 of 61 (57%)
disagreed due to concerns about risks of the procedure and
34% claimed family members were reluctant.
Conclusions: While gastrostomy feeding is widely accepted in
Western countries, it remains underused in Malaysia and other
Eastern countries. Our survey of health care professionals
interested in the care of older people suggests that most of
them will advocate PEG feeding. Further studies involving
other populations will help confirm whether this opinion varies
between healthcare settings.
59
O05
PRESSURE ULCERS ASSOCIATED MORTALITY AMONG OLDER
PATIENTS IN A LARGE TEACHING HOSPITAL IN MALAYSIA
H M Khor1, J Tan2, S B Kamaruzzaman1, A V Chin1, P J H Poi1, M P
Tan1
1. Division of Geriatric Medicine, Department of Medicine,
Faculty of Medicine, University of Malaya, Kuala Lumpur,
Malaysia
2. Emmanuel College, University of Cambridge, United Kingdom
Objective: Pressure ulcers are increasingly common with
age, with 70% occurring in people aged > 70years old. There
are currently no published national data on the prevalence
of pressure ulcers in Malaysia. The objective of this study is
to evaluate the risk factors associated with mortality among
patients with pressure ulcers.
Methods: A prospective observational study was performed
between Oct 2012 and May 2013. Patients with preexisting
pressure ulcers on admission and those with hospital acquired
pressure ulcers were recruited into the study. Information
on patient demographics, functional status, nutritional level,
stages of pressure ulcer and their complications were obtained.
Cox proportional hazard analysis was used to assess the risk of
death in all patients.
Results: 76/684 (11.1%) patients had pre-existing pressure
ulcers on admission and 30/684 (4.4%) developed pressure
ulcers in hospital. These patients were frail individuals
with multiple co-morbidities, poor functional status and
malnourished. There were 68 (66%) deaths by the end of the
median follow-up period of 12 (interquartile range 2.5 to 14)
weeks. Factors associated with mortality included nursing
home residence, pressure ulcer infection, stage IV pressure
ulcer, urinary incontinence, being bedbound, scoring high risk
on the Braden scale, hypoalbuminaemia and neutrophilia. Our
Cox regression model revealed that nursing home residence
(Hazard Ratio, HR= 2.33, 95% confidence interval, CI=1.30,
4.17; p=0.005), infected deep pressure ulcers (HR=2.21, 95%
CI=1.26, 3.87; p=0.006) and neutrophilia (HR=1.76; 95% CI 1.05,
2.94; p=0.031) were independent predictors of mortality in our
elderly patients with pressure ulcers.
Conclusion: The prevalence of pressure ulcers in our setting
is comparable to previously reported figures in Europe and
North America. Mortality in patients with pressure ulcer was
high, and was predicted by institutionalization and infection
with high neutrophils count. This information is invaluable in
informing healthcare decisions on life-prolonging treatment
and end-of-life care in this group of extremely frailty and highly
dependent individuals.