Authors (including presenting author) :
Shum CK(1), Shea YF(2), Tang M(2), Wan WH(3), Chan MMK(3), Wong WM(1), Chan NH(4), Ng MF(1), Mok CK(1), Kwan YK(1), Au Yeung TW(4)
Affiliation :
(1) Geriatric Division, Department of Medicine and Geriatrics, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
(2) Geriatric Division, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
(3) Li Ka Shing Faculty of Medicine, School of Nursing, University of Hong Kong, Hong Kong
(4) Geriatric Division, Department of Medicine and Geriatrics, Pok Oi Hospital and Tin Shui Wai Hospital, New Territories West Cluster, Hong Kong
Introduction :
Behavioral feeding problem negatively affects older people with advanced dementia. These people may have better oral intake when fed by close relatives. Unfortunately, during coronavirus disease 2019 (COVID-19) pandemic, visitor restrictions were imposed in residential care homes for the elderly (RCHEs) to limit the spread of infection among the most vulnerable. This reduced contact between older people and their relatives may have contributed to behavioral feeding problem.
Objectives :
To investigate the effects of visitor restrictions on feeding and its associated adverse outcomes in older RCHE residents.
Methodology :
Between 24 January 2020 (start of visitor restrictions in RCHEs in Hong Kong) and 31 May 2020 (before the third wave of COVID-19), RCHE residents (aged ≥65 years) admitted to acute medical and geriatric wards of Tuen Mun Hospital and Queen Mary Hospital for poor oral feeding were reviewed and those with advanced dementia (as indicated by a Global Deterioration Scale of 7) and poor oral feeding due to visitor restrictions and no other explainable cause [e.g. evidence of infection including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), depression, advanced malignancy or acute organ failure] were identified (study group). Those admitted for poor oral feeding during the same period in 2019 with advanced dementia and no explainable cause were defined as the control group. Baseline characteristics were collected. Study outcomes including admission, hospital length of stay, requirement of tube feeding were compared between groups.
Result & Outcome :
In the study group, 24 RCHE residents [aged (mean±SD) 89.7±8.0 years, women 83.3%] were admitted 64.5±30.9 days after the start of visitor restrictions whereas only 8 residents were in the control group. There was a significantly higher proportion of RCHE residents admitted for poor oral feeding due to a lack of visitors in 2020 than those with unexplainable poor oral feeding in 2019 [14.1% (24/170) vs. 3.4% (8/238), p< 0.001]. There was also a tendency to have a higher tube feeding rate in the study group (41.7% vs. 12.5%, p=0.13) and no significant difference in hospital length of stay [median (interquartile ranges) 8 (4–18) vs. 7 (9–13), p=0.21].
Oral feeding in older RCHE residents with advanced dementia could deteriorate during periods of visitor restrictions. Ways to improve feeding during these periods should be explored and tried to strike a balance between successful pandemic control and adverse consequences for older people. Future studies are needed to explore whether permitting close relatives to visit RCHE residents under special precautionary measures or having telecare (e.g. in terms of video calls) with close relatives during feeding can help to improve feeding and prevent its associated adverse outcomes in older people with advanced dementia.
