Careful hand feeding in a geriatric step-down hospital: a retrospective study

Abstract

Objective. To evaluate the safety and effectiveness of the careful hand feeding (CHF) programme in a geriatric step-down hospital.Methods. Medical records of patients aged ≥65 years who received CHF in Fung Yiu King Hospital between February 2017 and November 2021 were retrospectively reviewed.Results. 446 patients (178 men and 268 women) aged 66 to 109 (mean, 91) years were included for analysis. 88% of patients were severely frail or very severely frail. 70% of patients had advanced dementia. 81.3% of patients had dysphagia. 44% of patients were in imminent death status (who were highly likely to die within a week) before starting CHF. Food intake during CHF was poor or very poor in 51% of patients and satisfactory or good in 49% of patients. 90% of patients required clinically assisted hydration. The mean length of hospital stay was 19.3±16 days, and the mean duration of CHF was 14±13.5 days. 39% of patients died during the index admission; most of the remaining 61% of patients were discharged to their original placement. 27 (6%) patients had pneumonia. Independent predictors for pneumonia were the length of hospital stay (odds ratio=1.024, p=0.014) and poor/very poor intake (odds ratio=1.82, p=0.017). Conclusion.CHF is safe in a geriatric step-down hospital and avoids use of a nasogastric feeding tube in patients in their last phase of life. It fosters comfort and dignity for dying patients. Most patients can return to their original placement for CHF after discharge.

Careful hand feeding for people with eating and drinking difficulties and limited life expectancy

“…A holistic, multidisciplinary approach involving open communication, good relationships with families and caregivers, skilled problem solving, and respect for individual patients and their diverse needs are essential for high-quality nutritional care. [7][8][9][10][11][12] The Department of Medicine and Rehabilitation of Tung Wah Eastern Hospital developed a CHF management protocol for people with eating and drinking difficulties and limited life expectancy. This protocol aims to address complex feeding problems through shared decision making and a multidisciplinary approach.…”

Editorial

“…In this issue, Luk et al 5 report that careful hand feeding is feasible and safe in a geriatric step-down hospital, even during the COVID-19 pandemic. 5 It fosters comfort and dignity of the dying patients and respects the views of patients and family members.…”