Feeding-related hospitalizations and outcomes in advanced dementia

Dementia is a chronic disease characterized by progressive and mostly irreversible cognitive and functional decline. Advanced dementia is linked to high mortality and morbidity, with over 85% of patients experiencing feeding-related problems. Care should focus on comfort and quality of life, with medical societies recommending against tube feeding, supporting instead careful hand feeding. However, awareness among healthcare professionals regarding tube indications and complications remains limited.

To identify the frequency of hospitalizations related to feeding problems, analyze healthcare professionals' attitudes, and compare the outcomes of patients with and without tube feeding.

This retrospective, observational cohort study analyzed patients aged ≥ 65 years with advanced dementia admitted to Internal Medicine Department of Coimbra's Healthcare Integrated Delivery System between January 1 and March 31, 2023. Sociodemographic, clinical, feeding-related data, along with complications, mortality, and readmissions, were collected and analyzed via STATA.

Of the 1,735 admissions, 178 patients met the inclusion criteria (mean age 86; 64.5% female). Respiratory illnesses were the primary diagnosis (56.7%), and in-hospital mortality rate was 23%. Feeding-related hospitalizations occurred in 17.4% of the patients, mainly due to aspiration. At discharge, 102 patients had no feeding tube (Group A), and 76 did (Group B). Group B had significantly higher complication rates at one year than did Group A, without a survival benefit.

Our findings demonstrate that feeding-related complications also occur in patients receiving enteral tube feeding, without increasing survival or reducing complications and underscore the need for professional training and individualized evidence-based care in advanced dementia.