Comparison of survival and pneumonia risk in advanced dementia patients on nasogastric tube feeding versus careful hand feeding

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%) 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.