Natural History of Feeding-Tube Use in Nursing Home Residents With Advanced Dementia

Kuo, Sylvia; Rhodes, Ramona L.; Mitchell, Susan L.; Mor, Vincent; Teno, Joan M.

doi:10.1016/j.jamda.2008.10.010

Cited by 143 publications

(124 citation statements)

References 25 publications

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“…The oral dysbiosis that occurs with enteral tube feeding could be a health-threatening factor for frail elderly adults. Although performing a randomized controlled trial would be difficult, the poor outcome of enteral feeding in elderly adults has been reported in several observational studies (1,12,15,16,23,28). In addition, in our study, the incidence of pneumonia or fever and mortality in the following 6 months were significantly higher in the tube-fed subjects than in those fed orally, although this may have been due to differences in the baseline conditions of the two groups (data not shown).…”

Section: Discussionmentioning

confidence: 45%

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Enteral Tube Feeding Alters the Oral Indigenous Microbiota in Elderly Adults

Takeshita

Yasui

Tomioka

et al. 2011

Appl Environ Microbiol

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Enteral tube feeding is widely used to maintain nutrition for elderly adults with eating difficulties, but its long-term use alters the environment of the oral ecosystem. This study characterized the tongue microbiota of tube-fed elderly adults by analyzing the 16S rRNA gene. The terminal restriction fragment length polymorphism (T-RFLP) profiles of 44 tube-fed subjects were compared with those of 54 subjects fed orally (average age, 86.4 ؎ 6.9 years). Bar-coded pyrosequencing data were also obtained for a subset of the subjects from each group (15 tube-fed subjects and 16 subjects fed orally). The T-RFLP profiles demonstrated that the microbiota of the tube-fed subjects was distinct from that of the subjects fed orally (permutational multivariate analysis of variance [perMANOVA], P < 0.001). The pyrosequencing data revealed that 22 bacterial genera, including Corynebacterium, Peptostreptococcus, and Fusobacterium, were significantly more predominant in tube-fed subjects, whereas the dominant genera in the subjects fed orally, such as Streptococcus and Veillonella, were present in much lower proportions. Opportunistic pathogens rarely detected in the normal oral microbiota, such as Corynebacterium striatum and Streptococcus agalactiae, were often found in high proportions in tube-fed subjects. The oral indigenous microbiota is disrupted by the use of enteral feeding, allowing health-threatening bacteria to thrive.

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Section: Discussionmentioning

confidence: 45%

“…Nevertheless, tube feeding in the demented elderly remains controversial. Several studies have shown that tube feeding is associated with poor survival (1,16,23) and an increased risk of developing pneumonia (12,15,28).…”

mentioning

confidence: 99%

Enteral Tube Feeding Alters the Oral Indigenous Microbiota in Elderly Adults

Takeshita

Yasui

Tomioka

et al. 2011

Appl Environ Microbiol

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“…Thus, in a study (11) that evaluated the use of EN in institutionalized elderly people, the authors showed that 68.1% of the indications for feeding devices occurred in acute situations and in emergency services. There are no Brazilian studies about the indication of NET use in emergencies, but clinical practice shows that there are two distinct demands for the insertion of NET in this context: (1) from patients who search for hospital attendance, and due to an acute clinical condition receive the indication of tube insertion for the administration of medicines, water, or diet; and (2) from changes of tubes that were pulled, obstructed, or had any kind of bad functioning, in patients with chronic incapacity to be fed by mouth and, therefore, who were NET users already.…”

Section: Introductionmentioning

confidence: 99%

Nasoenteral tube: factors associated with delay between indication and use in emergency services

et al. 2017

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Objective: to know the time between indication and use of a nasoenteral tube (NET) and factors associated with delays. Method: A prospective cohort study that followed adults in a Brazilian emergency department, since the indication of the use of a NET, evaluating clinical variables and the work process. The Generalized Estimated Equations model was adopted to identify factors associated with the delays in each stage of the process. Results: the time between indication and use of NET was 573 (IQR: 360-1,093) minutes, in 150 insertions of NET. Insertions in patients who previously did not use it; delays in the medical, nutrition, and nursing care routine; use of mechanical ventilation; noradrenaline; and fasting were factors for longer time before the use of the tube. Conclusion: the time between indication and use of NET was high, exceeding 10 hours in half of the cases. Factors related to the clinical condition of the patient and to the care management would contribute to delays. Descriptors: Nursing Care; Emergency Medical Services; Gastrointestinal Intubation; Treatment Time; Patient Safety. RESUMO Objetivo: conhecer o tempo entre indicação e uso da sonda nasoenteral (SNE) e fatores associados a atrasos. Método: coorte prospectiva que acompanhou adultos de uma Emergência brasileira, desde a indicação ao uso da SNE, avaliando-se variáveis clínicas e do processo de trabalho. Adotou-se o modelo de Equações de Estimações Generalizadas para identifi car fatores associados a atrasos em cada etapa do processo. Resultados: o tempo entre indicação e uso da SNE foi 573 (IQR: 360-1093) minutos, em 150 inserções de SNE. Inserções em pacientes que anteriormente não a utilizavam, retardos na rotina assistencial médica, da nutrição e enfermagem, uso de ventilação mecânica, noradrenalina e jejum foram fatores para maior tempo até o uso da sonda. Conclusão: o tempo entre indicação e uso de SNE foi elevado, excedendo 10 horas em metade dos casos. Fatores relacionados às condições clínicas do paciente e à gestão da assistência contribuiriam para atrasos. Descritores: Cuidados de Enfermagem; Serviços Médicos de Emergência; Intubação Gastrointestinal; Tempo para o Tratamento; Segurança do Paciente. RESUMENObjetivo: conocer el tiempo entre indicación y uso de sonda nasogástrica (SNG) y factores asociados a demoras. Método: cohorte prospectivo que observó adultos en Servicio de Urgencia brasileño, desde indicación hasta uso de la SNG, evaluándose variables clínicas del proceso de trabajo. Se adoptó modelo de Ecuaciones de Estimación Generalizada para identifi car factores asociados a demoras en cada etapa del proceso. Resultados: el tiempo entre indicación y uso de SNG fue 573 (IQR=360α1093) minutos, en 150 inserciones de SNG. Las inserciones en pacientes que no la utilizaban previamente, demoras en rutina de atención médica, Rev Bras Enferm [Internet]. 2017 mar-apr;70(2):326-34. 327Nasoenteral tube: factors associated with delay between indication and use in emergency services

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“…12 The use of a feeding tube causes patient discomfort, increased use of restraints, and consequent greater likelihood of pressure sore development. 13,14 Studies showed that RCHE residents with feeding tubes are frequently transferred to an emergency department for tube complications such as blockage and dislodgement. 15 To date, studies have not shown survival benefits in older people with tube feeding.…”

Section: Pitfalls Of Tube Feedingmentioning

confidence: 99%