What is the most appropriate route to feed elderly patients with advanced dementia: oral or enteral?

• Author(s): Cintra,Marco Túlio Gualberto ; Rezende,Nilton Alves de ; Torres,Henrique Oswaldo da Gama
• Date: 2013
• Origin: Oasisbr
• Subject(s): Dementia, gastrostomy, enteral nutrition, mortality, deglutition disorders.
• Document Type: Journal article
• Language: English

Description

INTRODUCTION: Care of the elderly with dementia in advanced stages has important knowledge gaps, especially in those with oropharyngeal dysphagia in whom tube feeding, rather than oral feeding, is used as an alternative route. There are controversies about the systematic use of gastrostomy or enteral feeding to feed this population.
OBJECTIVES: To verify, through literature overview, the effectiveness of tube feeding in relation to survival, pneumonia incidence, prevalence and healing of pressure ulcers, nutritional status and quality of life.
METHODOLOGY: A database search in MEDLINE, LILACS and SciELO using as descriptors the Portuguese words for dementia, gastrostomy and enteral nutrition and their equivalents in English for the whole database existence until December 2012, limited to English, Portuguese and Spanish languages. We excluded editorials, non-systematic overviews and letters. Among the articles found, only prospective studies, or retrospective cohorts comparing elderly with alternative route feeding and patients with exclusive oral route, were selected for this overview.
RESULTS: Three hundred sixty four articles were found. Of these, only nine met all the selection criteria. The studies selected were not able to demonstrate benefits of gastrostomy and enteral nutrition in any of the variables studied in the elderly in an advanced stage of dementia.
CONCLUSION: There is no evidence in the literature that alternative routes of feeding improve survival outcomes, aspiration pneumonia, pressure ulcers, nutritional status and quality of life in patients with advanced stage dementia.