Survival of a cohort of elderly patients with advanced dementia:: nasogastric tube feeding as a risk factor for mortality

被引:45
作者
Alvarez-Fernández, B
García-Ordoñez, MA
Martínez-Manzanares, C
Gómez-Huelgas, R
机构
[1] Hosp Reg Carlos Haya, Unidad Geriatr, Malaga 29009, Spain
[2] Hosp Antequera, Serv Med Interna, Malaga, Spain
[3] Hosp Carlos Haya, Med Interna Serv, Malaga, Spain
关键词
advanced dementia; survival; mortality; nasogastric feeding; artificial nutrition;
D O I
10.1002/gps.1299
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Objectives To evaluate and identify factors determining survival in elderly patients with advanced dementia. Methods A prospective, follow-up, observational analysis in a cohort of 67 community-based patients aged 65 years or older with dementia defined by DSM-IV and stage 7A or above on the FAST scale. Data were recorded on socio-demographic from anthropometric and laboratory variables, FAST, Katz index, language, swallowing ability, diet, nutritional status data), associated diseases and medical complications during the previous 12 months. Survival was analyzed by the Kaplan-Meier method. Prognostic factors for survival were identified by the Cox proportional hazards regression model. Results The median follow-up was 832 days. The mean age was 82.2 +/- 6.7 years and 92.5% were women. A comorbid condition was present in 71.6%, most frequently hypertension (22.4%). A clinical event had occurred in 52 (77.6%) patients during the previous year (pneumonia, urinary infection, stroke, pressure sore, dehydration, sepsis or others). A total of 25 (37.3%) patients died. The mean survival was 676 days (95% confidence interval, 600-752 days). Cox proportional hazards model showed that independent prognostic factors for mortality were having pneumonia within the previous year (RR:3.7; p = 0.001). a permanent nasogastric tube (RR:3.5; p = 0.003) and serum albumin values below 3.5 g/dL (RR:2.9; p = 0.028). Conclusions Inpatients with advanced dementia, hypoalbuminemia and pneumonia are strongly and positively associated with mortality. Artificial nutrition via a nasogastric tube reduces survival in these patients. Copyright (c) 2005 John Wiley & Sons, Ltd.
引用
收藏
页码:363 / 370
页数:8
相关论文
共 56 条
[1]  
Alastrue A., 1993, Revista Espanola de Geriatria y Gerontologia, V28, P243
[2]   NOSOCOMIAL INFECTIONS IN LONG-TERM FACILITIES [J].
ALVAREZ, S ;
SHELL, CG ;
WOOLLEY, TW ;
BERK, SL ;
SMITH, JK .
JOURNALS OF GERONTOLOGY, 1988, 43 (01) :M9-S17
[3]  
ALVAREZFERNANDE.B, 2004, REV ESP GERIATR GERO, V39, P94
[4]  
American Psychiatric Association, 1993, Diagnostic and Statistical Manual of Mental Disorders, V4th
[5]  
Boersma F, 1999, INT J GERIATR PSYCH, V14, P748, DOI 10.1002/(SICI)1099-1166(199909)14:9<748::AID-GPS3>3.0.CO
[6]  
2-H
[7]   Audit of percutaneous endoscopic gastrostomy in long-term enteral feeding in a nursing home [J].
BourdelMarchasson, I ;
Dumas, F ;
Pinganaud, G ;
Emeriau, JP ;
Decamps, A .
INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, 1997, 9 (04) :297-302
[8]   Dementia, gastrostomy tubes, and mortality [J].
Brett, AS .
ARCHIVES OF INTERNAL MEDICINE, 2001, 161 (19) :2385-2386
[9]   Survival following a diagnosis of Alzheimer disease [J].
Brookmeyer, R ;
Corrada, MM ;
Curriero, FC ;
Kawas, C .
ARCHIVES OF NEUROLOGY, 2002, 59 (11) :1764-1767
[10]   Predictor index of mortality in dementia patients upon entry into long-term care [J].
Carlson, MC ;
Brandt, J ;
Steele, C ;
Baker, A ;
Stern, Y ;
Lyketsos, CG .
JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES, 2001, 56 (09) :M567-M570