Result & Outcome :
145 patients (92 women, 53 men) with an average age of (mean +/- SD) 91.5 +/- 7.5 (range 70-109) were studied. The principal diagnoses included advanced dementia [n=98, 68%], active cancer (n=16 , 11%), neurodegenerative disease (n=10, 7%), end-stage organ failure (n=19, 13%), and stroke (n=2, 1%). Prior to admission, most had with poor mobility and impaired functional state with an average Barthel Index (20) of 4.7 +/- 13. The reasons for considering nasogastric tube feeding initially were dysphagia (N=94, 65%), poor feeding (N=11, 7.6%), dysphagia and poor feeding (N=40, 27.6%). After commencing CHF, 114 (78.6%) cases were reviewed by Speech Therapists while 85 (58.6%) required dietetic input. CHF was assisted by family members in 65 (44.8%) patients. However, only 32 (49%) of these 65 carers came to hospital regularly to feed the patients. The average duration of CHF were 15 +/- 15.3 days (range 1 to 83 days). 32 patients on CHF had to stop early: 8 because of pneumonia, 21 because of decreased conscious state, and 3 because family changed their mind and decided to use enteral feeding. Reductions in the use of parenteral hydration (N=137 vs N=127, p< 0.001) and physical restraint (N=47 vs N=40, P< 0.05) were observed after CHF. In all, 85 (58.6%) patients passed away during the index admission. 60 (41.4%) patients recovered and were discharged back to nursing homes (N=55) and home (N=5). Amongst these 60 patients, 9 (15%) and 36 (60%) passed away in one month and 6 months respectively.
Conclusion CHF is feasible in a geriatric step-down hospital. It benefits the patients by avoiding nasogastric tube insertion in their last phase of life. It fosters comfort and dignity of the dying patients and acknowledges the views of patients and family members
