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Takenoshita S, Kondo K, Okazaki K, Hirao A, Takayama K, Hirayama K, Asaba H, Nakata K, Ishizu H, Takahashi H, Nakashima-Yasuda H, Sakurada Y, Fujikawa K, Yokota O, Yamada N, Terada S. Tube feeding decreases pneumonia rate in patients with severe dementia: comparison between pre- and post-intervention. BMC Geriatr 2017; 17:267. [PMID: 29157223 PMCID: PMC5697435 DOI: 10.1186/s12877-017-0662-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background It is widely supposed that there is no benefit, including extended survival and decreased rate of pneumonia, in patients with severe dementia receiving enteral tube feeding (TF). However, there have been few studies comparing the frequency of pneumonia before and after TF in severe dementia. Methods Nine psychiatric hospitals in Okayama Prefecture participated in this retrospective survey. All inpatients fulfilling the entry criteria were evaluated. All subjects suffered from difficulty in oral intake. Attending physicians thought that the patients could not live without long-term artificial nutrition, and they decided whether or not to make use of long-term artificial nutrition from January 1, 2014 to December 31, 2014. Results We evaluated 58 patients including 46 with TF and 12 without. The mean age of all patients was 79.6 ± 9.0 years old. Patients with probable Alzheimer’s disease (n = 38) formed the biggest group, and those with vascular dementia the second (n = 14). Median survival times were 23 months among patients with TF and two months among patients without TF. The start of TF decreased the frequency of pneumonia and the use of intravenous antibiotics. Conclusions TF decreased pneumonia and antibiotic use, even in patients with severe dementia. The results of this study do not necessarily indicate that we should administer TF to patients with severe dementia. We should consider the quality of life of patients carefully before deciding the use or disuse of TF for patients with severe dementia.
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Affiliation(s)
- Shintaro Takenoshita
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Keiko Kondo
- Department of Psychiatry, Sekizen Hospital, Tsuyama, Japan
| | | | - Akihiko Hirao
- Department of Psychiatry, Kawada Hospital, Okayama, Japan
| | - Keiko Takayama
- Department of Psychiatry, Kibogaoka Hospital, Tsuyama, Japan
| | | | - Hiroyuki Asaba
- Department of Psychiatry, Kohnan Hospital, Tamano, Japan
| | - Kenji Nakata
- Department of Psychiatry, Taiyo Hills Hospital, Takahashi, Japan
| | - Hideki Ishizu
- Department of Psychiatry, Zikei Hospital, Okayama, Japan
| | | | | | - Yasue Sakurada
- Department of Psychiatry, Mannari Hospital, Okayama, Japan
| | - Kengo Fujikawa
- Department of Psychiatry, Kinoko Espoir Hospital, Kasaoka, Japan
| | - Osamu Yokota
- Department of Psychiatry, Kinoko Espoir Hospital, Kasaoka, Japan
| | - Norihito Yamada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Seishi Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
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Takayama K, Hirayama K, Hirao A, Kondo K, Hayashi H, Kadota K, Asaba H, Ishizu H, Nakata K, Kurisu K, Oshima E, Yokota O, Yamada N, Terada S. Survival times with and without tube feeding in patients with dementia or psychiatric diseases in Japan. Psychogeriatrics 2017; 17:453-459. [PMID: 29178502 DOI: 10.1111/psyg.12274] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 03/01/2017] [Accepted: 03/14/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is widely supposed that there has been no evidence of increased survival in patients with advanced dementia receiving enteral tube feeding. However, more than a few studies have reported no harmful outcome from tube feeding in dementia patients compared to in patients without dementia. METHODS This was a retrospective study. Nine psychiatric hospitals in Okayama Prefecture participated in this survey. All inpatients fulfilling the entry criteria were evaluated. All subjects suffered from difficulty with oral intake. Attending physicians thought that the patients could not live without long-term artificial nutrition. The physicians decided whether to make use of long-term artificial nutrition between January 2012 and December 2014. RESULTS We evaluated 185 patients. Their mean age was 76.6 ± 11.4 years. Of all subjects, patients with probable Alzheimer's disease (n = 78) formed the biggest group, schizophrenia patients (n = 44) the second, and those with vascular dementia (n = 30) the third. The median survival times were 711 days for patients with tube feeding and 61 days for patients without tube feeding. In a comparison different types of tube feeding, median survival times were 611 days for patients with a nasogastric tube and more than 1000 days for those with a percutaneous endoscopic gastrostomy tube. CONCLUSION Patients with tube feeding survived longer than those without tube feeding, even among dementia patients. This study suggests that enteral nutrition for patients with dementia prolongs survival. Additionally, percutaneous endoscopic gastrostomy tube feeding may be safer than nasogastric tube feeding among patients in psychiatric hospitals.
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Affiliation(s)
- Keiko Takayama
- Department of Psychiatry, Kibogaoka Hospital, Tsuyama, Japan
| | | | - Akihiko Hirao
- Department of Psychiatry, Kawada Hospital, Okayama, Japan
| | - Keiko Kondo
- Department of Psychiatry, Sekizen Hospital, Tsuyama, Japan
| | - Hideki Hayashi
- Department of Psychiatry, Hayashi Hospital, Okayama, Japan
| | - Koichi Kadota
- Department of Psychiatry, Kurashiki Jinpu Hospital, Kurashiki, Japan
| | - Hiroyuki Asaba
- Department of Psychiatry, Kohnan Hospital, Tamano, Japan
| | - Hideki Ishizu
- Department of Psychiatry, Zikei Hospital, Okayama, Japan
| | - Kenji Nakata
- Department of Psychiatry, Taiyo Hills Hospital, Takahashi, Japan
| | - Kairi Kurisu
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Etsuko Oshima
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Osamu Yokota
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Norihito Yamada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Seishi Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Abe K, Yamashita R, Kondo K, Takayama K, Yokota O, Sato Y, Kawai M, Ishizu H, Nakashima T, Hayashi H, Nakata K, Asaba H, Kadota K, Tanaka K, Morisada Y, Oshima E, Terada S. Long-Term Survival of Patients Receiving Artificial Nutrition in Japanese Psychiatric Hospitals. Dement Geriatr Cogn Dis Extra 2016; 6:477-485. [PMID: 27843445 PMCID: PMC5091231 DOI: 10.1159/000448242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background/Aims Most patients with dementia suffer from dysphagia in the terminal stage of the disease. In Japan, most elderly patients with dysphagia receive either tube feeding or total parenteral nutrition. Methods In this study, we investigated the factors determining longer survival with artificial nutrition. Various clinical characteristics of 168 inpatients receiving artificial nutrition without oral intake in psychiatric hospitals in Okayama Prefecture, Japan, were evaluated. Results Multiple logistic regression analysis showed that the duration of artificial nutrition was associated with a percutaneous endoscopic gastrostomy (PEG) tube, diagnosis of mental disorder, low MMSE score, and absence of decubitus. Conclusion Patients with mental disorders survived longer than those with dementia diseases on artificial nutrition. A PEG tube and good nutrition seem to be important for long-term survival.
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Affiliation(s)
- Keiichi Abe
- Department of Psychiatry, Mannari Hospital, Okayama, Japan
| | | | - Keiko Kondo
- Department of Psychiatry, Sekizen Hospital, Tsuyama, Japan
| | - Keiko Takayama
- Department of Psychiatry, Kibogaoka Hospital, Tsuyama, Japan
| | - Osamu Yokota
- Department of Psychiatry, Kinoko Espoir Hospital, Kasaoka, Japan
| | - Yoshiki Sato
- Department of Psychiatry, Yura Hospital, Tamano, Japan
| | - Mitsumasa Kawai
- Department of Psychiatry, Setouchi Kinen Hospital, Setouchi, Japan
| | - Hideki Ishizu
- Department of Psychiatry, Zikei Hospital, Okayama, Japan
| | | | - Hideki Hayashi
- Department of Psychiatry, Hayashi Hospital, Okayama, Japan
| | - Kenji Nakata
- Department of Psychiatry, Taiyo Hills Hospital, Takahashi, Japan
| | - Hiroyuki Asaba
- Department of Psychiatry, Kohnan Hospital, Tamano, Japan
| | - Koichi Kadota
- Department of Psychiatry, Kurashiki Jinpu Hospital, Kurashiki, Japan
| | | | - Yumi Morisada
- Department of Psychiatry, Kurashiki Shinkeika Hospital, Kurashiki, Japan
| | - Etsuko Oshima
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Seishi Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Withholding versus withdrawing treatment: artificial nutrition and hydration as a model. Curr Opin Support Palliat Care 2016; 10:208-13. [DOI: 10.1097/spc.0000000000000225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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