Outcomes of enteral nutrition for patients with advanced dementia — A systematic review

Abstract

The present article aims to evaluate the outcomes of enteral nutrition for people with advanced dementia. A systematic review was conducted by searching The Cochrane Library, MEDLINE, EMBASE, PROQUEST and LILACS for articles that were published from 2008 to 2013. Prospective and retrospective studies involving a control group were searched. Data were independently extracted and assessed by one reviewer and checked by a second. Searched outcomes included survival, clinical and nutritional parameters and complications. In total, nine controlled studies were identified from several parts of the world: Israel, Italy, Japan, the United States and Brazil. Most of the studies did not report any outcome of harm with enteral nutrition use in dementia patients compared with patients without dementia. A study with a higher follow-up period demonstrated improvements in albumin, weight and chronic inflammation parameters. It is not possible to affirm that tube feeding is harmful for dementia patients. Thus, an adequate follow-up by a multidisciplinary team may lower complications associated with this therapy and thus improve survival.

Survival times with and without tube feeding in patients with dementia or psychiatric diseases in Japan

“…It was also reported by another systematic review that most existing studies had found no harmful outcomes from enteral nutrition use in dementia patients compared to in patients without dementia . Additionally, this review noted improvements in nutrition and a reduction of inflammation due to tube feeding that had been reported by a study with long follow‐up periods . Moreover, a few recent studies reported dementia patients with tube feeding survived longer than those without tube feeding …”

“…However, the quality of the evidence is mostly poor and relatively old . It was also reported by another systematic review that most existing studies had found no harmful outcomes from enteral nutrition use in dementia patients compared to in patients without dementia . Additionally, this review noted improvements in nutrition and a reduction of inflammation due to tube feeding that had been reported by a study with long follow‐up periods .…”

Tube feeding decreases pneumonia rate in patients with severe dementia: comparison between pre- and post-intervention

“…A systematic review evaluating the consequences of TF for patients with severe dementia reported no evidence of extension of survival time in patients receiving enteral TF [ 4 ], but the quality of the evidence is mostly poor and relatively old [ 5 ]. Recently, another systemic review stated that most studies found no harmful outcome with enteral nutrition use in patients with severe dementia [ 6 ], and improvement in nutrition and reduction of inflammation due to TF were reported by a study with long follow-up periods [ 7 ].…”

Manejo das demências em fase avançada: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia

“…Whenever tube feeding is contraindicated, assisted oral feeding is encouraged. The concept of “comfort feeding only” 125 ) is useful in such situations: it is based on feeding with comfort as its main goal, i.e., focusing on satisfaction and stopping whenever feeding is distressing.…”