Enteral nutrition, health status and perceived quality of life in advanced dementia: oservational study

Objectives– To evaluate the impact of enteral nutrition on 18-month survival, rehospitalization rate and quality of life perceived by caregivers in a cohort of elderly patients with advanced dementia discharged from hospital. Methods– With a prospective observational study design, 196 multimorbid (≥3 chronic comorbidities) elderly (≥65 years) with advanced dementia (FAST≥5, CDR≥2) discharged alive from hospital were consecutively enrolled (68 M, mean age 82±8 years). Tube feeding through PEG (percutaneous endoscopic gastrostomy) was carried out in all patients with dysphagia and life expectancy greater than 30 days (59 subjects). Others (137 patients) were fed orally. After a mean follow-up of 17±6 months, survival, hospital readmissions and perceived quality of life were assessed through a telephonic interview with caregivers through a modified version of DEMQOL questionnaire. Results- Mortality rate was 67% in PEG group (median survival 7.5 months) and 37% in the oral group (median survival 28 months, p<0.0001 with Kaplan-Meier method). However, after correction for age, sex and dementia staging (FAST and CDR), the survival rate was similar in both groups (median survival 15vs15 months, p=0.35). Hospital readmission rate (29%vs29%) and perceived quality of life (good 55%vs55%, acceptable 25%vs25%, poor 20%vs20%) were not statistically different between PEG and oral group. Conclusions- Tube feeding does not seem to affect prognosis and perceived quality of life in elderly multimorbid patients with advanced dementia. Tube feeding is generally carried out in patients with a more severe disease and perhaps too late in clinical course.