The journal of nutrition, health & aging

, Volume 19, Issue 2, pp 169–177 | Cite as

Outcomes of enteral nutrition for patients with advanced dementia — A systematic review

  • Ana Lucia Ribeiro SalomonEmail author
  • M. R. Carvalho Garbi Novaes


The present article aims to evaluate the outcomes of enteral nutrition for people with advanced dementia. A systematic review was conducted by searching The Cochrane Library, MEDLINE, EMBASE, PROQUEST and LILACS for articles that were published from 2008 to 2013. Prospective and retrospective studies involving a control group were searched. Data were independently extracted and assessed by one reviewer and checked by a second. Searched outcomes included survival, clinical and nutritional parameters and complications. In total, nine controlled studies were identified from several parts of the world: Israel, Italy, Japan, the United States and Brazil. Most of the studies did not report any outcome of harm with enteral nutrition use in dementia patients compared with patients without dementia. A study with a higher follow-up period demonstrated improvements in albumin, weight and chronic inflammation parameters. It is not possible to affirm that tube feeding is harmful for dementia patients. Thus, an adequate follow-up by a multidisciplinary team may lower complications associated with this therapy and thus improve survival.

Key words

Home care services enteral nutrition dementia Alzheimer’s disease outcomes 


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  1. 1.
    World Heath Organization. International Code of Diseases: WHO; 2010 [cited 2013 June 18].].Google Scholar
  2. 2.
    Martins AS, Rezende NA, Torres HOG. Sobrevida e complicações em idosos com doenças neurológicas em nutrição enteral. Rev Assoc Med Bras. 2012;58(6):691–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Finucane TE, Christmas C, Leff BA. Tube feeding in dementia: how incentives undermine health care quality and patient safety. J Am Med Dir Assoc. 2007;8:205–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. Cochrane Database of Systematic Reviews [Internet]. 2012; (11).Google Scholar
  5. 5.
    Priefer BA, Robbins J. Eating changes in mild-stage Alzheimer’s disease: a pilot study. Dysphagia. 1997;12(4):212–21. PubMed PMID: 9294942. eng.CrossRefPubMedGoogle Scholar
  6. 6.
    Kimyagarov S, Turgeman D, Fleissig Y, Klid R, Kopel B, Adunsky A. Percutaneous endoscopic gastrostomy (PEG) tube feeding of nursing home residents is not associated with improved body composition parameters. J Nutr Health Aging. 2013 Feb;17(2):162–5. PubMed PMID: 23364496. eng.CrossRefPubMedGoogle Scholar
  7. 7.
    Palecek EJ, Teno JM, Casarett DJ, Hanson LC, Rhodes RL, Mitchell SL. Comfort feeding only: a proposal to bring clarity to decision-making regarding difficulty with eating for persons with advanced dementia. J Am Geriatr Soc. 2010 Mar;58(3):580–4. PubMed PMID: 20398123. Pubmed Central PMCID: PMC2872797. eng.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Teno JM, Mitchell SL, Gozalo PL, Dosa D, Hsu A, Intrator O, et al. Hospital characteristics associated with feeding tube placement in nursing home residents with advanced cognitive impairment. JAMA. 2010 Feb;303(6):544–50. PubMed PMID: 20145231. Pubmed Central PMCID: PMC2847277. eng.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Teno JM, Gozalo P, Mitchell SL, Kuo S, Fulton AT, Mor V. Feeding Tubes and the Prevention or Healing of Pressure Ulcers. Arch Intern Med. 2012;172(9):697–701.CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Sorrell JM. Use of feeding tubes in patients with advanced dementia: are we doing harm? J Psychosoc Nurs. 2010;48:15–8.Google Scholar
  11. 11.
    Regnard C, Leslie P, Crawford H, Matthews D, Gibson L. Gastrostomies in dementia: bad practice or bad evidence? Age Ageing. 2010 May;39(3):282–4. PubMed PMID: 20178994. eng.CrossRefPubMedGoogle Scholar
  12. 12.
    Gaines DI, Durkalski V, Patel A, DeLegge MH. Dementia and cognitive impairment are not associated with earlier mortality after percutaneous endoscopic gastrostomy. JPEN J Parenter Enteral Nutr. 2009 2009 Jan-Feb;33(1):62–6. PubMed PMID: 18827070. eng.CrossRefPubMedGoogle Scholar
  13. 13.
    Higaki F, Yokota O, Ohishi M. Factors predictive of survival after percutaneous endoscopic gastrostomy in the elderly: is dementia really a risk factor? Am J Gastroenterol. 2008 Apr;103(4):1011–6; quiz 7. PubMed PMID: 18177448. eng.CrossRefPubMedGoogle Scholar
  14. 14.
    Jaul E, Singer P, Calderon-Margalit R. Tube feeding in the demented elderly with severe disabilities. IMAJ. 2006;8:870–4.PubMedGoogle Scholar
  15. 15.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, (1994).Google Scholar
  16. 16.
    Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. Newcastle- Ottawa Quality Assessment Scale-Cohort Studies Canada: Ottawa Hospital Research Institute; [cited 2012 7th May, 2012]. Available from: Scholar
  17. 17.
    Associação Médica Brasileira. O processo de elaboração, validação e implementação das diretrizes clínicas na Saúde Suplementar no Brasil. In: AMB, editor. Brazil.Google Scholar
  18. 18.
    Venturini C, Sparvoli D, Jukic-Peladic N, Orlandone P. PP078-SUN Demented vs non demented patients: clinical outcomes and complications of home enteral nutrition (hen) among frail elderly patients. Clin Nutr Suppl. 2012;7(1):57.CrossRefGoogle Scholar
  19. 19.
    Arinzon Z, Peisakh A, Berner YN. Evaluation of the benefits of enteral nutrition in long-term care elderly patients. J Am Med Dir Assoc. 2008;9.Google Scholar
  20. 20.
    Kumagai R, Kubokura M, Sano A, Shinomiya M, Ohta S, Ishibiki Y, et al. Clinical evaluation of percutaneous endoscopic gastrostomy tube feeding in Japanese patients with dementia. Psychiatry Clin Neurosci. 2012;66:418–22.CrossRefPubMedGoogle Scholar
  21. 21.
    Shintani S. Efficacy and ethics of artificial nutrition in patients with neurologic impairments in home care. J Clin Neurosci. 2013 Feb;20(2):220–3. PubMed PMID: 23228657. eng.CrossRefPubMedGoogle Scholar
  22. 22.
    McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009 2009 May-Jun;33(3):277–316. PubMed PMID: 19398613. eng.CrossRefPubMedGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France 2014

Authors and Affiliations

  • Ana Lucia Ribeiro Salomon
    • 1
    Email author
  • M. R. Carvalho Garbi Novaes
    • 2
  1. 1.Nutritionist of the Health Department of the Federal DistrictDoctor in Health Sciences - University of Brasilia, Coordinator of the Clinical Nutrition Residency of Hospital Regional da Asa NorteBrasíliaBrazil
  2. 2.Hospital Pharmaceutics of the Health Department of the Federal DistrictPost-doctoral in Ethics in Clinical Research - Universidad del Chile, Professor of Medicine - ESCS-Fepecs, Coordinator of Ethics Committee of Fepecs/SES-DFBrasíliaBrazil

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