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

Area of Science:

• Geriatrics
• Palliative Care
• Clinical Nutrition

Background:

• Tube feeding is common in advanced dementia, despite limited evidence of benefit.
• An alternative feeding approach was needed for end-of-life care in this population.

Purpose of the Study:

• To evaluate the impact of a careful hand feeding program on feeding tube insertion rates.
• To identify risk factors associated with feeding tube insertion.
• To compare oral feeding sustainability and hospital readmission rates between hand feeding and tube feeding.

Main Methods:

• Retrospective cohort study of advanced dementia patients (≥60 years) admitted with feeding problems.
• Compared feeding tube insertion rates before and after program implementation.
• Used logistic regression to identify risk factors for tube feeding.

Main Results:

• Feeding tube insertion rates decreased significantly from 72% to 51% post-program implementation (p<.001).
• Key risk factors for tube feeding included admission timing, dysphagia, and lack of advance care planning.
• 91% of patients on careful hand feeding maintained oral intake over 12 months, with no significant difference in hospital readmission rates compared to tube feeding.

Conclusions:

• A hospital-based careful hand feeding program effectively reduced feeding tube use in advanced dementia.
• The program facilitated sustained oral feeding for the majority of patients.
• Hospital readmission rates remained high and were comparable between hand feeding and tube feeding groups.