A decision aid regarding long-term tube feeding targeting substitute decision makers for cognitively impaired older persons in Japan: A small-scale before-and-after study

Kuraoka, Yumiko; Nakayama, Kazuhiro

doi:10.1186/1471-2318-14-16

Cited by 19 publications

(24 citation statements)

References 16 publications

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“…Our results are similar to other studies evaluating nutrition management decision aids for cardiovascular risk reduction, nutrition support in advanced dementia, and heart failure self‐care, which have found that the decision aids were helpful, 27 , 28 clear, 27 , 28 balanced, 27 , 29 , 30 useful, 29 , 30 appropriate in length, 27 with a “just right” amount of information, 29 , 30 and with information presented well 29 , 30 . Our participants’ concerns about the length of the decision aid echoes that of Kuraoka and Nakayama, 28 who reported that their 17‐page decision aid on nutrition support in advanced cognitive impairment was rated as too long by 33% of respondents.…”

Section: Discussionsupporting

confidence: 90%

Decision Aid for Nutrition Support in Pediatric Oncology: A Pilot Study

Sajeev

Cohen

Wakefield

et al. 2016

J Parenter Enteral Nutr

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Section: Discussionsupporting

confidence: 90%

Decision Aid for Nutrition Support in Pediatric Oncology: A Pilot Study

Sajeev

Cohen

Wakefield

et al. 2016

J Parenter Enteral Nutr

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“…However, the proportion of patients being discharged to their homes was also not high in either group, suggesting that most of the elderly patients with dysphagia requiring ANH were bound to stay in long-term care facilities rather than their own homes regardless of receiving PEG feeding or TPN. It is necessary to provide patients and their family members with information regarding the general clinical course to aid their decision-making process before initiating ANH [46]; our results add to such clinical information for supporting the decision-making process.…”

Section: Discussionmentioning

confidence: 99%

Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in the elderly with dysphagia: A propensity-matched cohort study

Masaki

Kimura

2019

Preprint

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21Background 22 The long-term outcomes of artificial nutrition and hydration (ANH) in the elderly with 23 dysphagia remain uncertain. Enteral nutrition via percutaneous endoscopic gastrostomy 24 (PEG) and total parenteral nutrition (TPN) are major methods of ANH. Although both 25 can be a life-prolonging treatments, Japan has recently come to view PEG as 26 representative of unnecessary life-prolonging treatment. Consequently, TPN is often 27 chosen for ANH instead. This study aimed to compare the long-term outcomes between 28 PEG and TPN in the elderly. 29 Methods 30This single-center retrospective cohort study identified 253 elderly patients with 31 dysphagia who received enteral nutrition via PEG (n=180) or TPN (n=73) between 32 January 2014 and January 2017. The primary outcome was survival time. Secondary 33 outcomes were oral intake recovery, discharge to home, and the incidence of severe 34 pneumonia and sepsis. We performed one-to-one propensity score matching using a 0.05 35 caliper. The Kaplan-Meier method, log-rank test, and Cox proportional hazards model 36 were used to analyze the survival time between groups. 37 Results 38Older patients with lower nutritional states, and severe dementia were more likely to 39 receive TPN. Propensity score matching created 55 pairs. Survival time was significantly 40 longer in the PEG group (median, 317 vs 195 days; P=0.017). The hazard ratio for PEG 41 relative to TPN was 0.60 (95% confidence interval: 0.39-0.92; P=0.019). There were no 42 significant differences between the groups in oral intake recovery and discharge to home. 43The incidence of severe pneumonia was significantly higher in the PEG group (50.9% vs 44 25.5%, P=0.010), whereas sepsis was significantly higher in the TPN group (10.9% vs 45 30.9%, P=0.018). 46 Conclusions 47PEG was associated with a significantly longer survival time, a higher incidence of 48 severe pneumonia, and a lower incidence of sepsis compared with TPN. These results can 49 be used in the decision-making process before initiating ANH. 50 51 4 56 developed as an enteral feeding technique for pediatric patients with dysphagia [1,2]. 57Compared to feeding via a nasogastric tube, enteral feeding via PEG can relieve 58 laryngopharyngeal discomfort and prevent intervention failure; therefore, its use has 59 become widespread for long-term enteral feeding in multiple patient groups including 60 pediatric and geriatric populations [3]. However, studies have reported worse outcomes 61 following PEG feeding in patients with dementia [4,5]; therefore, the use of PEG in 62 elderly populations is controversial [6,7]. 63TPN is another common method of nutritional management [8,9]. Similar to tube 64 feeding, TPN is also occasionally used for ANH in elderly patients with dysphagia [10]. 65 Comparing the outcomes of enteral nutrition and parenteral nutrition are major concerns 66 among clinicians. Previous studies have demonstrated conflicting results among patients 67 who received enteral nutrition versus those who received parenteral nutr...

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“…It is true that Japanese families and care professionals tend to make decisions on behalf of elders (Kuraoka & Nakayama, ). However, recognition of the importance of involving patients themselves and their families together in decision‐making processes has been increasing (Miyata et al., ).…”

Section: Discussionmentioning

confidence: 99%

International reflections on caring for people with advanced dementia

Yumoto

Kernohan

Morioka

et al. 2018

Public Health Nursing

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Dementia is causing global concern with its massive impacts on affected individuals, families, society, and national economies. As the disease progresses, patients' needs increase in number, depth, and breadth, covering physical, psychological, social, and spiritual domains. Care varies from place to place, from country to country and from east to west. To learn from some of these variations, we explored advanced dementia care in United Kingdom and Japan. Informed by an overview of literature on care of people with advanced dementia, we reflected on direct nonparticipant observations of care in urban areas of Northern Ireland and Japan. While we identified a common purpose to address the complex needs of people living with dementia, there were differences in the approach to care. Broadly, dementia care in United Kingdom tends toward person-centered care with a strong interest in Advance Care Planning as part of a palliative care approach. In Japan, we found less evidence of early stage palliative care and more of family-based decision making to inform care of older people. In both countries, dementia care varies regionally, being more available in some areas than others. International knowledge exchange and further comparative studies will help to improve care for people with advanced dementia, everywhere. K E Y W O R D Scross-cultural comparison, dementia, Japan, northern Ireland, palliative care

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A decision aid regarding long-term tube feeding targeting substitute decision makers for cognitively impaired older persons in Japan: A small-scale before-and-after study

Cited by 19 publications

References 16 publications

Decision Aid for Nutrition Support in Pediatric Oncology: A Pilot Study

Decision Aid for Nutrition Support in Pediatric Oncology: A Pilot Study

Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in the elderly with dysphagia: A propensity-matched cohort study

International reflections on caring for people with advanced dementia

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