Abstract
Objectives
The current study aimed to conduct a systematic review and meta-analysis to explore
the efficacy and safety of tube feeding in patients with advanced dementia.
Design
Systematic review and meta-analysis.
Setting and Participants
PubMed, Medline, Embase, and Cochrane Library were searched from inception until March
7, 2020, to obtain relevant studies.
Intervention
Feeding with nasogastric tube or percutaneous endoscopic gastrostomy (PEG).
Measures
We evaluated the associations of tube feeding and the risk of mortality, period of
survival days, tube-related complications, and nutritional status. Data from original
studies were synthesized by using a random-effects model. Each selected article was
assessed for bias using the Newcastle-Ottawa Scale. A narrative synthesis and pooled
analyses are reported.
Results
Twelve trials were eligible, involving 1805 patients with tube feeding (mean age:
82.8 years; 71.3% female) and 3861 without tube feeding (mean age: 82.7; 68.7% female).
For mortality rate, patients with advanced dementia with tube feeding are associated
with significantly higher mortality rate [k = 8; odds ratio (OR) 1.79; 95% confidence interval (CI) 1.04–3.07; P = .03]. Initially, no association was found for the risk of pneumonia and pressure
sore between groups. However, sensitivity analysis showed patients with advanced dementia
with PEG tube feeding have significantly higher risk of pneumonia (OR 3.56; 95% CI
2.32–5.44; P < .001) and pressure sore (OR 2.25; 95% CI 1.92–2.63; P < .001). Finally, no association was found for the survival period and nutritional
status between groups.
Conclusions and Implications
This meta-analysis indicates that tube feeding is associated with increased mortality
rate and possible tube-related complications, but not improves with prolonging survival
days and nutritional status. Shared decision-making routinely before insertion of
a tube between caregivers and physicians is recommended.
Keywords
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Article info
Publication history
Published online: July 28, 2020
Footnotes
Y.F.L. and T.W.H. contributed equally as first authors.
The authors declare no conflicts of interest.
This work was supported by Kaohsiung Veterans General Hospital (Grant VGHKS109–070).
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
