Effect of feeding mode on survival and 28-day hospital readmissions in patients with advanced cognitive impairment with feeding problems: a retrospective cohort study

Background: Nasogastric tube feeding tubes are commonly used in patients with advanced cognitive impairment and feeding problems. Nonetheless, careful hand feeding has been advocated. This study aimed to compare the effect of nasogastric tube feeding versus oral feeding on survival and 28-day hospital readmissions in patients with advanced cognitive impairment and feeding problems. Methods: We retrospectively reviewed records of 454 patients aged a60 years with advanced cognitive impairment admitted to two convalescent hospitals between February 2017 and June 2019 who were indicated for nasogastric tube feeding and were followed up for a minimum of 1 year. Patients initiated on nasogastric tube feeding were compared with those continued on oral feeding. Survival analysis was performed using the Kaplan-Meier method. F?ognostic factors for mortality were identified using multivariate Cox proportional hazards regression models. Results: Of 454 patients (60.4% women) [mean age, 89.2±7.4 years], 228 (50.2%) were initiated on nasogastric tube feeding and 226 (49.8%) were continued on oral feeding after rejecting the nasogastric tube feeding recommendation. 72.7% of patients were residents in residential care homes for the elderly. The median survival was 138 days (95% confidence interval [Cl] =84-191 days). Multivariate analysis using Cox regression showed no significant difference in survival between the two groups (adjusted hazard ratio [HR]=1.08, 95% Q=0.85-1.37). The prognostic factors for mortality were age (HR=1.75, p=0.033), albumin level (HR=1.63, p=0.028), and Norton score (HR=1.90, p=0.034). There was no significant difference in 28-day hospital readmission rates (47.8% vs 41.6%, p=0.183). Conclusion: Nasogastric tube feeding and oral feeding were comparable in terms of survival and 28-day hospital readmission in patients with advanced cognitive impairment and feeding problems.