Association between palliative care and life-sustaining treatments for patients with dementia: A nationwide 5-year cohort study

Chen, Ping-Jen; Liang, Fu-Wen; Ho, Chung‐Han; Cheng, Shao‐Yi; Chen, Yi‐Chen; Chen, Yuhan; Chen, Yueh-Chun

doi:10.1177/0269216317751334

Cited by 29 publications

(45 citation statements)

References 34 publications

(50 reference statements)

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“…[52] Tube feeding paradoxically higher in palliative care group, this finding also found in many Asia studies . [53,54] In Asia culture belief, artificial nutrition is basic care for dying patients to prevent become 'hungry ghosts'. [55] Our study does have limitations.…”

Section: Results Discussionmentioning

confidence: 99%

Choosing and Doing Wisely: Triage Level I Resuscitation a Possible New Field for Starting Palliative Care and Avoiding Low-Value Care-A nationwide matched-pair retrospective cohort study

Lin

Lee

2020

Preprint

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Background The association between palliative care and life-sustaining treatment for patients following emergency department (ED) resuscitation is unclear.Objective To analyze ED triage level I resuscitation patients the use of palliative care and its life-sustaining treatment usage based on a national representative sample of a population of about 2.3 million.Methods A matched-pair retrospective cohort study was conducted to examine the association between palliative care and the outcome variables using multivariate logistic regression and Kaplan–Meier survival analyses.Participants: Between 2009 and 2013, 336 ED triage level I resuscitation patients received palliative care services (palliative care group) in a universal health insurance scheme. Retrospective cohort control selection was matched using a 1:4 ratio for confounding factors with those who received usual care (usual care group).Main outcomes Outcome variables include numbers of emergency and outpatient department visits, hospitalization days, total medical expenses, life-sustaining treatment utilization, and days of survival after the ED triage level I resuscitation index date.Results The mean survival post-ED triage level I resuscitation days was less than one year, that, fit the end-of-life definition. Palliative care services provided to 15% of ED triage level I resuscitation patients. The palliative care group was more consistently and significantly associated with less life-sustaining treatment use than the usual care group.Conclusion Palliative care decisions correlate with the reduction of life-sustaining treatments for patients receiving triage level I resuscitation. Furthermore, triage level Ⅰ resuscitation status may present a possible new field for starting palliative care intervention and reducing low-value care.

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Section: Results Discussionmentioning

confidence: 99%

Choosing and Doing Wisely: Triage Level I Resuscitation a Possible New Field for Starting Palliative Care and Avoiding Low-Value Care-A nationwide matched-pair retrospective cohort study

Lin

Lee

2020

Preprint

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“…Outcomes were pneumonia risk, hospitalization rate, duration of hospitalization and one-year mortality in the AHF and NGF groups. The diagnosis of pneumonia was cautiously made by reviewing the charts of the patients: [1] admission records, [2] discharge reviews, and [3] diagnosis with pneumonia or aspiration pneumonia. We did not include subjects with pneumonia diagnosis in outpatient records.…”

Section: Outcome Measurementsmentioning

confidence: 99%

“…Life-sustaining treatments in severe dementia remain a major issue. Palliative care decreases lifesustaining interventions, except for tube feeding [3].…”

Section: Introductionmentioning

confidence: 99%

Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison

2020

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Background: All individuals with severe dementia should be offered careful hand feeding. However, under certain circumstances, people with severe dementia have a feeding tube placed. In Taiwan, tube feeding rate in demented older home care residents is increasing; however, the benefits of tube feeding in this population remain unknown. We compared the clinical prognosis and mortality of older patients with severe dementia receiving nasogastric tube feeding (NGF) or assisted hand feeding (AHF). Methods: Data from the in-home healthcare system between January 1 and December 31, 2017 were analyzed to identify 169 participants over 60 years of age in this retrospective longitudinal study. All subjects with severe dementia and complete functional dependence suffered from difficulty in oral intake and required either AHF or NGF. Data were collected from both groups to analyze pneumonia, hospitalization, and mortality rates. Results: A total of 169 subjects (56 males and 113 females, aged 85.9 ± 7.5 years) were analyzed. 39 required AHF and 130 NGF. All subjects were bedridden; 129 (76%) showed Barthel index < 10. Pneumonia risk was higher in the NGF group (48%) than in the AHF group (26%, p = 0.015). After adjusting for multiple factors in the regression model, the risk of pneumonia was not significantly higher in the NGF group compared with the AHF group. Oneyear mortality rates in the AHF and NGF groups were 8 and 15%, respectively, and no significant difference was observed after adjustment with logistic regression (aOR = 2.38; 95% CI, 0.58-9.70). There were no significant differences in hospitalization rate and duration. Conclusions: For older patients with dementia requiring in-home healthcare, NGF is not associated with a significantly lower risk of pneumonia than AHF. Additionally, neither mortality nor hospitalization rates decreased with NGF. On the contrary, a nonsignificant trend of increased risk of pneumonia was observed in NGF group. Therefore, the benefits of NGF are debatable in older patients with severe dementia requiring in-home healthcare. Continued careful hand feeding could be an alternative to NG feeding in patients with severe dementia. Furthermore, large-scale studies on in-home healthcare would be required to support these results.

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“…Lifesustaining treatments in severe dementia remain a major issue. Palliative care decreases lifesustaining interventions, except for tube feeding (3).…”

Section: Introductionmentioning

confidence: 99%

Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison

Chou

Tsou

Hwang

2020

Preprint

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Backgrounds: All individuals with severe dementia should be offered careful hand feeding. However, under certain circumstances, people with severe dementia have a feeding tube placed. In Taiwan, tube feeding rate in demented older home care residents is increasing however, the benefits of tube feeding in this population remain unknown. We compared the clinical prognosis and mortality of older patients with severe dementia receiving nasogastric tube feeding (NGF) or assisted hand feeding (AHF).Methods: This retrospective longitudinal study enrolled 169 participants over 60 years of age in the setting of in-home healthcare between January 1 and December 31, 2017. All subjects with documented severe dementia and complete functional dependence suffered from difficulty in oral intake and required either AHF or NGF. Data were collected from both groups to analyze pneumonia, hospitalization, and mortality rates.Results: A total of 169 subjects (56 males and 113 females, aged 85.9 ± 7.5 years) were analyzed. Of note, 39 required AHF and 130 NGF. All subjects were bedridden; 129 (76%) showed Barthel index < 10. Pneumonia risk was higher in the NGF group (48%) than in the AHF group (26%, p = 0.015). After adjusting for multiple factors in the regression model, the risk of pneumonia was not significantly higher in older subjects belonging to the NGF group compared to the AHF group. One-year mortality rates in the AHF and NGF groups were 8% and 15%, respectively, and no significant difference was observed after adjustment with logistic regression (aOR = 2.38; 95% CI, 0.58-9.70). There were no significant differences in hospitalization rate and duration.Conclusions: For older patients with dementia requiring in-home healthcare, NGF is not associated with a significantly lower risk of pneumonia than AHF. Additionally, neither mortality nor hospitalization rates decreased with NGF. On the contrary, a non-significant trend of increased risk of pneumonia was observed in NGF group. Therefore, the benefits of NGF are debatable in older patients with severe dementia requiring in-home healthcare. Continued careful hand feeding could be an alternative to NG feeding in patients with severe dementia. Furthermore, large-scale studies on home healthcare would be required to support these results.3

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Association between palliative care and life-sustaining treatments for patients with dementia: A nationwide 5-year cohort study

Cited by 29 publications

References 34 publications

Choosing and Doing Wisely: Triage Level I Resuscitation a Possible New Field for Starting Palliative Care and Avoiding Low-Value Care-A nationwide matched-pair retrospective cohort study

Choosing and Doing Wisely: Triage Level I Resuscitation a Possible New Field for Starting Palliative Care and Avoiding Low-Value Care-A nationwide matched-pair retrospective cohort study

Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison

Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison

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