Search

Background and Aims: European and international guidelines advice against initiating tube-feeding in patients with severe dementia. These recommendations are based on studies with important methodological limitations that evaluated the benefits of artificial nutrition in patients with percutaneous endoscopic gastrostomy almost exclusively in terms of the prolongation of survival. The aims of this study were to assess the harmful effects of home enteral nutrition administered via the nasogastric tube and percutaneous endoscopic gastrostomy in patients with advanced dementia in terms of mechanical, gastrointestinal and metabolic complications, to estimate the survival, to explore the risk factors for mortality and to compare the outcomes of patients with advanced dementia with those of patients without dementia., Methods: The retrospective observational study was carried out on 585 consecutive patients of the mean age of 85.6 ± 6.9 years. They were treated using home enteral nutrition from 2010 to 2015 according to follow-up protocols adopted by the Clinical Nutrition Unit of an Italian geriatric research hospital (IRCCS-INRCA, Ancona). Incidence rates of mechanical, gastrointestinal and metabolic complications and survival rates in patients with severe dementia were compared to those in patients without dementia. The Cox proportional hazards model was used to evaluate the mortality risk factors., Results: There was no difference between the incidence rates of complications in patients with severe dementia and those in patients without dementia. The incidence of mechanical complications was 1.35/1000 days for patients without dementia vs. 1.53/1000 days for patients with dementia (p = 0.270), the incidence of gastrointestinal complications was 1.30/1000 days for patients without dementia vs. 1.35/1000 days for patients with dementia (p = 0.984) and the incidence of metabolic complications was 0.36/1000 days for patients without dementia vs. 0.35/1000 days for patients with dementia (p = 0.252). The Kaplan Mailer analyses showed that there was no evidence to support the theses on poorer prognosis of survival of patients with dementia (median survival was 193 days for patients without dementia vs. 192 days for patients with dementia, (p > 0.05)). The female gender, advanced age, nasogastric tube, diabetes mellitus and chronic renal failure were identified as risk factors. Subjects whose Geriatric Nutritional Risk Index values were higher had a lower risk of mortality., Conclusions: The discussion on the appropriateness of enteral nutrition in patients with severe dementia is still open. Our results show that, if there is a medical prescription for tube-feeding and a patient's surrogate decision-makers express free and informed consent to the tube-feeding of the patient, enteral nutrition should not be contraindicated a priori if the patient has severe dementia. Regular follow-up is mandatory to guarantee adherence to the therapy and achieve its initial aims and to ensure that the principles of beneficence and nonmaleficence are respected., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objective: To assess the prevalence of malnutrition according to the new ESPEN definition in a population of geriatric hospital patients and to determine how malnutrition affects the length of hospital stay (LOS) and hospital mortality., Design: A retrospective analysis of data gathered during nutritional screening surveys carried out three consecutive years, from 2012 to 2014, in an Italian geriatric research hospital (INRCA, Ancona) was performed. On the day of the study, demographic data, data on clinical conditions and the nutritional status of newly admitted patients were collected. Patients were screened for malnutrition risk using the Malnutrition Universal Screening Tool (MUST). Subsequently, malnutrition was diagnosed, for subjects at high risk, following the criteria suggested by the European Association for Clinical Nutrition and Metabolism [body mass index (BMI) < 18.5 kg/m 2 or different combinations of unintentional weight loss over time and BMI values]. Sensitivity, specificity, positive and negative predictive value of MUST compared to ESPEN criteria were assessed. The characteristics of patients with a diagnosis of malnutrition were compared to those of non-malnourished patients. The impact of malnutrition on LOS and hospital mortality was investigated through logistic and linear regression models., Setting: The study was performed in an Italian geriatric research hospital (INRCA, Ancona)., Subjects: Two hundred eighty-four newly hospitalized geriatric patients from acute care wards (mean age 82.8 ± 8.7 years), who gave their written consent to participate in the study, were enrolled., Results: According to the MUST, high risk of malnutrition at hospitalization was found in 28.2% of patients. Malnutrition was diagnosed in 24.6% of subjects. The malnutrition was an independent predictor of both the LOS and hospital mortality. The multivariate analyses-linear and logistic regression-were performed considering different potential confounders contemporarily. The results showed that the malnutrition is an independent predictor of LOS and hospital mortality. Malnourished subjects were hospitalized almost 3 days longer compared to non-malnourished patients ( p  = 0.047; CI 0.04-5.80). The risk of death during hospitalization was 55% higher for malnourished patients ( p  = 0.037; CI 0.21-0.95)., Conclusion: A new ESPEN consensus of malnutrition was easily applicable in a population of geriatric hospital patients. Given that the nutritional status of geriatric patients was strongly correlated with the LOS and hospital mortality, the use of this simple and non-time consuming tool is highly recommended in clinical practice.

Aim: To determine whether the outcomes of home enteral nutrition for frail older patients can be improved by video consultation between home visiting staff and a hospital physician, specialized in clinical nutrition, during monthly home visits., Methods: A randomized prospective study out of patients aged older than 65 years receiving home enteral nutrition from the Department of Clinical Nutrition of an Italian geriatric hospital in 2013 was carried. A total of 100 patients were randomly assigned to receive video consultation in addition to regular monthly home visits, 88 patients only had regular monthly home visits. Therapy outcomes - incidence rates of complications, outpatient hospital visits and hospitalizations - were compared between two groups. A logistic regression analysis was carried out to evaluate the usefulness of the video consultation to improve therapy outcomes., Results: Incidence rates for metabolic and gastrointestinal complications were significantly lower for patients who received a video consultation, respectively: 0.032/year "video consultation" versus 0.055/year "no video consultation" (P = 0.0001) and 0.006/year "video consultation" versus 0.028/year "no video consultation" (P < 0.0001). No differences were found for incidence rates of mechanical complications, outpatient hospital visits and hospitalizations. Logistic regression showed that the video consultation was significantly correlated with a reduction of metabolic complications (OR 2.63, 95% CI 1.00-6.91; P = 0.049 after adjustment for duration of home enteral nutrition and diabetes mellitus 2)., Conclusion: The present study provides evidence that a video consultation between home visiting staff and hospital physicians specialized in clinical nutrition during monthly home visits is associated with a reduction of metabolic complications in a population of frail older patients. Geriatr Gerontol Int 2015; ●●: ●●-●●., (© 2015 Japan Geriatrics Society.)