Study: Link Between Pneumonia and Tube Feeding of Advanced Dementia Patients

A study by a team from the HKU Faculty of Medicine (HKUMed) found that there is no significant difference in one-year survival probability among advanced dementia patients on nasogastric tube feeding or careful hand feeding (125 days versus 145 days, (Graph 1). But those on nasogastric tube feeding have a 40 percent higher risk of contracting pneumonia, (Graph 2). Courtesy of HKUMed

Patients with advanced dementia with feeding problems such as poor oral intake and dysphagia (difficulty swallowing) are often fed by a nasogastric tube to reduce the risk of aspiration pneumonia and improving survival. However, a recent study by Li Ka Shing Faculty of Medicine (HKUMed) found that patients with advanced dementia who were fed by tube had no advantage in survival compared with those who were carefully fed by hand, but had a 40 percent higher risk of contracting pneumonia.

The retrospective cohort study identified 764 patients with advanced dementia considered for tube feeding due to feeding problems. The findings showed that patients initiated on careful hand feeding had a risk of pneumonia 40 percent lower than those on nasogastric tube feeding. Among patients with both behavioral eating problems and dysphagia, nasogastric tube feeding was associated with a higher risk of pneumonia than manual feeding.

In addition, There was no significant difference in one-year survival between the nasogastric tube fed and carefully hand fed groups, with a median survival of 125 and 145 days respectively.

Postulated mechanisms for increased aspiration risk with nasogastric tube feeding include impairment of the lower esophageal sphincter, desensitization of the pharyngo glottal reflex, and reflux of gastric contents into the pharynx.

In recent years, some geriatric wards in Hong Kong hospitals have begun to offer the option of careful hand feeding as an alternative to tube feeding to promote comfort and quality of life in end-of-life advanced dementia patients with swallowing problems. The results of this study confirm the benefits of manual feeding, which not only improves the quality of life of patients with advanced dementia, but also has the potential to reduce the risk of pneumonia.

“As the practice of tube feeding in advanced dementia patients remains prevalent in Hong Kong and many parts of the world, this research highlights the need for further education of the public and healthcare providers to improve evidence-based practice around tube feeding decisions in dementia patients,” said Dr. Jacqueline Yuen Kwan-yuk, Clinical Assistant Professor of the Division of Geriatrics, Department of Medicine, School of Clinical Medicine, HKUMed, who lead the study.

This study is the first in Hong Kong to compare the risk of pneumonia and death in hospitalized patients with advanced dementia under careful manual feeding and nasogastric tube feeding. The research article is now published online in the Journal of Post-Acute and Long-Term Care Medicine.