Does Non-Beneficial Nasogastric Tube Feeding Occur During End-of-Life Care? An Audit of Outcomes for Those with a Malnutrition Universal Screening Tool Score of 2.

Abstract

Background: The consideration of artificial nutrition and hydration (ANH) is recommended for individuals with reduced nutritional intake. However, placing long-term nonoral feeding tubes is not appropriate in those with advanced dementia or if the individual is likely to die imminently-"within hours or days" (GMC, 2010;58). In some instances, the provision of ANH in the weeks leading up to death may be considered a "Non-Beneficial Treatment." Objective: To determine the extent to which "non-beneficial" nasogastric tube (NGT) feeding occurs at the end of life. Design: An audit of outcomes for individuals with a Malnutrition Universal Screening Tool (MUST) score of 2 who may be considered for artificial nutrition. Methods: All admissions to an acute hospital trust who met the following criteria: ≥65 years old and MUST score (Malnutrition Universal Screening Tool) of ≥2 over a six-month period (September '21-February '22). 1765 individuals met the inclusion criteria. For analysis, individuals were grouped by the presence of an NGT flag and admission survival. Results: 84 (4.8%) had NGT procedure flags. Of these 84, 28 (33%) died during admission. A further 12 died within six months. In total 40 (47.6%) of 84 NGT-flagged individuals were deceased within six months. Chi-square analysis demonstrated a significant relationship between death during admission and NGT Flag (χ² = 36.888, df = 1, p = < 0.001). Individuals with NGT flags who passed away were significantly older than peers who survived the admission (t = 2.576, df = 82, p = 0.012). Conclusions: NGT insertions in this cohort have a high likelihood of being considered "non-beneficial." Frailty associated with increasing age may be a factor.