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What is The Best Way to Nourish a Dementia Patient?

Jennifer Celtrick SN
Jackson College
Background
Dementia is a term that defines a broad range of symptoms.
Associated with a decline in memory and cognition that begins
mildly and gradually progresses resulting in loss of function and
ability to perform tasks of daily living.
Alzheimers disease accounts for 60 to 80 percent of cases.
Vascular dementia is the second most common type and usually
occurs after a stroke.
Average life expectancy after diagnosis is 8 years.
Feeding problems developed in 86% of persons with advanced
dementia with a mortality rate of 39% at 6 months after onset.
Taste changes in the early stages result from taste and smell
dysfunction, medications, or depression which leads to reduced oral
intake.
2015 Michigan Alzheimers Statistics for 65+
- 152,612,105, current 65+ state population estimate from 2014
- 180,000 people diagnosed with a projected increase to 220,000 by
the year 2025, a 22.2% change
- 12% of seniors are living with Alzheimers
- 6th leading cause of death, 3,220 deaths for the year 2012
- 508,000 caregivers, most often family, performed 578 million
hours of unpaid care in 2014, total value of care equaled
7,035,000 dollars and health care costs for caregivers equaled
305 million dollars.

Results

Clinical Implications

Conclusions

Oral Feedings

Current research showed oral feedings resulted in the best outcome


for nutrition and hydration as well as quality of life.
Assisted oral feedings should be available to all individuals with
advanced dementia. Neglect is this area is not acceptable.
Recommend against the use of artificial nutrition and hydration
unless for a one week trial period to assess benefits of intervention.
Ethically permissible to withhold artificial nutrition and hydration at
the advanced stages when oral intake is no longer possible.
Revision of clinical practice to meet current evidenced based
research on the benefits, risks, and recommendations of oral
feedings and tube feedings.
Education of clinicians on the current evidenced based research to
garner the most appropriate course of treatment decision for the
patient.
Education of the caregiver on the current evidenced based risks,
benefits, and recommendations regarding oral feedings and tube
feedings to allow for the most informed care decision possible.
Education and support of professional and family caregivers on
techniques of assisted oral feedings.
Multi-disciplinary coordination of care with appropriate ancillary staff
i.e. nutrition services, speech therapy etc..
Promote awareness that dementia is a terminal illness.
Promote the importance of making an Advanced Directive early in
the disease process to ensure patient's wishes are respected once
they can no longer speak for themselves.

In accordance with the current evidence based research it is


recommended that assisted oral feedings be the primary source of
hydration and nutrition, even in the advanced stages of dementia, and
allows for preservation of dignity and optimal quality of life. Education
and support services for techniques of assisted oral feedings should
be offered.

Pros
Preservation of dignity
Preservation of pleasure from
eating
Promote bonding with caregiver,
who most often is a family
member
Increased social interaction at
meal times
Increased attention
Modification of environment and
external stimuli to promote eating
May help maintain weight
May help promote wound healing
Supplementation and appetite
enhancers can be used in
combination

Cons

Aspiration
Patient resistance to feeding
Distress from choking and coughing
Time consuming

(Daniel, PhD, RN, K., Rhodes, MD, MPH, MSCS, R.,


Vitale, MD, C., & Shega, MD, J. (2014). )
(Hanson, L., Ersek, M., Gilliam, R., & Carey, T. (n.d.) )
(Rose, K., & Lopez, R. (2012).)

Tube feedings are not recommended due to the risks outweighing


the benefits and results in compromised human dignity, reduced
quality of life, and increased mortality and morbidity but if chosen
should be done on a trial basis. It is ethically permissible to withhold
this intervention at the advanced stages when oral intake is no longer
possible.
Many times there is no advance directive stating final wishes and
those left behind agonize over treatment options and subsequent
decisions. Education of clinicians and caregivers on the current
evidence is vital so that the best informed care decision can be made.
A revision of clinical practice and implementation of institution wide
policy change to meet current evidenced based research on the risks
and benefits of oral and artificial hydration and nutrition as it relates to
dementia patients is recommended.
(Assisted Oral Feeding and Tube Feeding. (2011, September 1).)
(Daniel, PhD, RN, K., Rhodes, MD, MPH, MSCS, R., Vitale, MD, C., & Shega, MD, J. (2014). )

(Alzheimer's Progression - Alzheimer's Association. (2011).)


(Hanson, L., Ersek, M., Gilliam, R., & Carey, T. (n.d.))
(Assisted Oral Feeding and Tube Feeding. (2011, September 1).)

(Hanson, L., Ersek, M., Gilliam, R., & Carey, T. (n.d.). )

Tube Feedings

(Michigan Alzheimer's Statistics. (2015). )

Methods

In adults 50+ with dementia what is the best method of providing


nutrition based on results from Clinical trial, Randomized controlled or
non-controlled trial, Systematic Review, Meta-analysis, and Evidenced
based clinical guidelines that compared the risks and benefits of oral
and tube feedings.
Progression of illness and severity of symptoms vary from person
to person and the results of these studies can be used to improve
quality of life and facilitate the decision making process for end of life
care.

Pros
May help prevent serious
complications if used in the early
stages of malnutrition
Decreased distress for patients
who experience coughing and
choking with oral feedings
G-tube may allow for
preservation of ability to perform
basic ADLs
Dehydration relief
May help maintain weight

Cons
Adverse effects on quality of life
- Decreased social interaction
at mealtimes
- Less attention received due to
delivery method of feeding
Increased mortality, morbidity
Compromised human dignity
Increased discomfort
Aspiration
G-Tube site complications
- Inflammation of stoma
- Cellulitis
- Excoriation
Diarrhea
Nausea and vomiting
Loss of pleasure of eating
Fluid Overload
GI and venous distention
Peritonitis
Development of new pressure
ulcers
Increased use of physical and
chemical restraints
Tube occlusions
No long term proven benefits
No guarantee of improved
survival

(Table 2 and 4, Schwartz, D., Barrocas, A., Wesley,


J., Kliger, G., Pontes-Arruda, A., Marquez, H., . . .
Ditucci, A. (2014). )
(Daniel, PhD, RN, K., Rhodes, MD, MPH, MSCS, R.,
Vitale, MD, C., & Shega, MD, J. (2014))

RESEARCH POSTER PRESENTATION DESIGN 2015

www.PosterPresentations.com

(Daniel, PhD, RN, K., Rhodes, MD, MPH, MSCS, R., Vitale, MD, C., & Shega, MD, J. (2014).)
(Schwartz, D., Barrocas, A., Wesley, J., Kliger, G., Pontes-Arruda, A., Marquez, H., . . . Ditucci, A. (2014))
(Schwartz, D., Barrocas, A., Wesley, J., Kliger, G., Pontes-Arruda, A., Marquez, H., . . . Ditucci, A. (2014).)

(Michigan QuickFacts from the US Census Bureau. (2015). )


(What Is Dementia? (2015). )

(Rose, K., &) Lopez, R. (2012))

Bibliography
Alzheimer's Progression - Alzheimer's Association. (2011). Retrieved November 14, 2015,
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Assisted Oral Feeding and Tube Feeding. (2011, September 1). Retrieved November 14,
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Daniel, PhD, RN, K., Rhodes, MD, MPH, MSCS, R., Vitale, MD, C., & Shega, MD, J. (2014).
American Geriatrics Society Feeding Tubes in Advanced Dementia Position Statement.
Journal of the American Geriatrics Society J Am Geriatr Soc, 62(8), 1590-1593.
doi:10.1111/jgs.12924
Hanson, L., Ersek, M., Gilliam, R., & Carey, T. (n.d.). Oral Feeding Options for People with
Dementia: A Systematic Review. Journal of the American Geriatrics Society, 59(3), 463-472.
doi:10.1111/j.1532-5415.2011.03320.x
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(Cross, S. (2013, June 19))

Michigan QuickFacts from the US Census Bureau. (2015). Retrieved November 14, 2015, from
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Rose, K., &) Lopez, R. (2012). Transitions in Dementia Care: Theoretical Support for Nursing
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Schwartz, D., Barrocas, A., Wesley, J., Kliger, G., Pontes-Arruda, A., Marquez, H., . . . Ditucci,
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Life. Nutrition in Clinical Practice, 829-840. doi:10.1177/0884533614546890
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