Comparison of Survival and Pneumonia Risk in Advanced Dementia Patients on Nasogastric Tube Feeding versus Careful Hand Feeding.

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Pub Date : 2025-08-12 DOI:10.1093/gerona/glaf165

Jacqueline K Yuen,Rachelle Bernacki,Felix H W Chan,Tuen-Ching Chan,David T Y Chow,Yat-Fung Shea,Betty L H Ng,Karen M K Chan,Xue Li,Qi-Man Shi,James K H Luk

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Abstract

BACKGROUND Nasogastric tube feeding is commonly used for enteral nutrition in individuals with advanced dementia with feeding difficulties, but its impact on survival and pneumonia risk compared to careful hand feeding remains controversial. This study aimed to compare one-year survival and pneumonia risk in individuals with advanced dementia initiated on nasogastric tube feeding versus those receiving careful hand feeding. METHODS A prospective propensity score-matched cohort study was conducted. Participants included individuals aged ≥60 years with advanced dementia and feeding problems admitted to two geriatric hospitals between September 2020 and September 2022. Propensity-score matched cohorts were analyzed using Kaplan-Meier survival analysis and Cox proportional hazards regression models. RESULTS Among 283 participants (mean age 89.8 years, 62.2% female, 73.5% residential care home residents), 184 (65.0%) were received careful hand feeding and 99 (35.0%) nasogastric tube feeding. A matched subsample of 176 participants (116 careful hand feeding, 60 nasogastric tube feeding) was analyzed. One-year adjusted survival did not differ significantly between the nasogastric tube feeding and careful hand feeding groups (AHR= 0.85, 95% CI, 0.59-1.23, P =.38). However, the nasogastric tube feeding group had a significantly higher one-year adjusted pneumonia risk compared to the careful hand feeding group (AHR 1.60, 95% CI, 1.06-2.42, P =.03). CONCLUSIONS Individuals with advanced dementia initiated on nasogastric tube feeding do not have meaningfully improved survival and have a higher risk of pneumonia compared to those receiving careful hand feeding. These findings can guide clinicians and families when considering feeding tube placement for individuals with advanced dementia.

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晚期痴呆患者鼻胃管喂养与小心手喂的生存率及肺炎风险比较。

研究背景：鼻胃管喂养通常用于晚期痴呆患者的肠内营养，但与手喂相比，其对生存和肺炎风险的影响仍存在争议。本研究旨在比较晚期痴呆患者鼻胃管喂养与手喂的一年生存率和肺炎风险。方法采用前瞻性倾向评分匹配队列研究。参与者包括在2020年9月至2022年9月期间入住两家老年医院的年龄≥60岁的晚期痴呆患者和饮食问题患者。使用Kaplan-Meier生存分析和Cox比例风险回归模型对倾向评分匹配的队列进行分析。结果283例患者（平均年龄89.8岁，女性62.2%，居住在安老院中73.5%）中，184例（65.0%）采用精心手工喂养，99例（35.0%）采用鼻胃管喂养。分析了176名参与者的匹配子样本（116名小心手喂，60名鼻胃管喂）。鼻胃管喂养组和细心手喂组的1年调整生存率无显著差异（AHR= 0.85, 95% CI, 0.59-1.23, P = 0.38）。然而，鼻胃管喂养组的1年校正肺炎风险明显高于手动喂养组（AHR 1.60, 95% CI, 1.06-2.42, P = 0.03）。结论：与手饲相比，采用鼻胃管喂养的晚期痴呆患者的生存率并没有显著提高，而且患肺炎的风险更高。这些发现可以指导临床医生和家庭考虑为晚期痴呆患者放置饲管。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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The Journals of Gerontology Series A: Biological Sciences and Medical Sciences

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