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Hospital Careful Hand Feeding Program Reduced Feeding Tube Use in Patients with Advanced Dementia

  • Original Research
  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

Tube feeding is prevalent among patients with advanced dementia despite empirical data that suggest its lack of benefit. To provide an alternative to tube feeding for end-of-life patients, a careful hand feeding program was launched in a Hong Kong geriatric convalescent hospital in February 2017. We aim to compare the rates of feeding tube insertion before and after program implementation and determine risk factors for feeding tube insertion. For patients on careful hand feeding, we evaluated their sustainability on oral feeding and the rates of hospital readmissions compared with tube feeding patients over the next 12 months.

Design

Retrospective cohort study.

Setting and Participants

Advanced dementia patients ≥60 years with indication for tube feeding due to feeding problems admitted from January 2015–June 2019.

Methods

Data was collected on demographic and clinical variables, initial feeding mode (careful hand feeding vs. tube feeding), subsequent feeding mode changes, and hospital admissions over the next 12 months. Rates of feeding tube insertion, sustainability on oral feeding, and hospital readmissions were compared using Chi-square test. Risk factors for feeding tube insertion were assessed using logistic regression models.

Results

Among 616 advanced dementia patients admitted with feeding problems, feeding tube insertion rate declined significantly after careful hand feeding program implementation (72% vs 51% p<.001). Independent risk factors for feeding tube insertion were admission prior to program implementation, presence of dysphagia alone, dysphagia combined with poor intake, and lack of advance care planning. Among patients on careful hand feeding, 91% were sustained on oral feeding over the next twelve months and did not differ significantly before or after careful hand feeding program implementation (p=.67). There was no significant difference in hospital readmission rates between careful hand feeding patients and tube feeding patients before (83% vs 86%, p=.55) and after careful hand feeding program implementation (87% vs 85%, p=.63).

Conclusions and Implications

A hospital careful hand feeding program significantly reduced the feeding tube insertion rate among advanced dementia patients with feeding problems. The vast majority of patients on careful hand feeding were sustained on oral feeding over the next 12 months but their rate of hospital readmissions remained similarly high after program implementation.

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Funding

Funding sources: This work was supported by the University of Hong Kong Seed Fund for Basic Research (Grant 201904185003).

Author information

Authors and Affiliations

  1. Division of Geriatrics, LKS Faculty of Medicine, The University of Hong Kong, 4/F Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China

    Jacqueline K. Yuen, F. H. W. Chan & S. T.-W. Chu

  2. Department of Medicine and Geriatrics, TWGHs Fung Yiu King Hospital, Hong Kong SAR, China

    T.-C. Chan, Y.-F. Shea & J. K. H. Luk

  3. Department of Speech Therapy, TWGHs Fung Yiu King Hospital and Grantham Hospital, Hong Kong SAR, China

    D. T. Y. Chow

Authors
  1. Jacqueline K. Yuen
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  2. F. H. W. Chan
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  3. T.-C. Chan
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  4. D. T. Y. Chow
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  5. S. T.-W. Chu
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  6. Y.-F. Shea
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  7. J. K. H. Luk
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Corresponding author

Correspondence to Jacqueline K. Yuen.

Additional information

Conflict of interest: All authors have no interests to declare.

Ethical standards: This study was approved by the Institutional Review Board of The University of Hong Kong/Hospital Authority Hong Kong West Cluster (UW 19-527).

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Yuen, J.K., Chan, F.H.W., Chan, TC. et al. Hospital Careful Hand Feeding Program Reduced Feeding Tube Use in Patients with Advanced Dementia. J Nutr Health Aging 27, 432–437 (2023). https://doi.org/10.1007/s12603-023-1926-9

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  • DOI: https://doi.org/10.1007/s12603-023-1926-9

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