Nasogastric Tube vs Careful Hand Feeding on Pneumonia Risk in Advanced Dementia

microscopic pneumonia in lungs
microscopic pneumonia in lungs
Researchers evaluated the effects of nasogastric tube feeding vs careful hand feeding on survival outcomes and the risk for pneumonia among older patients with advanced dementia.

Although survival outcomes were similar with nasogastric tube feeding (NGF) compared with careful hand feeding (CHF) among patients with advanced dementia, NGF was associated with an increased risk for pneumonia. These findings were published in JAMDA.

Data for this retrospective cohort study were collected from the Hong Kong Hospital between 2015 and 2019. Patients (N=764) with advanced dementia and feeding problems who received NGF (n=464) or CHF (n=300) were evaluated for 1-year pneumonia and mortality outcomes.

Among patients included in the study, the mean age was 88.8 years, 61.1% were women, and 74.2% resided in a skilled nursing facility. Patients in the NGF group were younger (P <.001) and fewer were widowed (P =.03) compared with those in the CHF group.

After stratification by feeding problem, the researchers found that patients in the NGF group had increased rates of dysphagia (59.1% vs 37.0%) but decreased rates of behavioral-related feeding problems (20.9% vs 51.7%) vs those in the CHF group (both P <.001).

A total of 54.9% of patients developed aspiration pneumonia, with increased rates observed among patients in the NGF group vs those in the CHF group (64.6% vs 35.4%; P =.02). Similar findings were observed between the NGF vs CHF groups for the occurrence of pneumonia (60.3% vs 48.0%; P =.004).

Predictors for pneumonia included male sex (hazard ratio [HR], 1.41; 95% CI, 1.04-1.91; P =.03), NGF (HR, 1.41; 95% CI, 1.08-1.85; P =.01), aspiration pneumonia (1.31; 95% CI, 1.01-1.70; P =.04), and BMI (HR, 0.97; 95% CI, 0.93-1.00; P =.04). The occurrence of pneumonia among patients with NGF was increased for those with both dysphagia and behavioral-related feeding problems (P =.001).

The rate of mortality at 1 year also was similar between patients in the NGF and CHF groups (64.0% vs 62.7%, respectively; P =.55). Predictors for mortality included aspiration pneumonia (HR, 1.39; 95% CI, 1.14-1.69; P =.001), active pressure injury (HR, 1.29; 95% CI, 1.07-1.56; P =.01), Charlson comorbidity index score (HR, 1.19; 95% CI, 1.09-1.29; P <.001), age (HR, 1.04; 95% CI, 1.03-1.06; P <.001), albumin concentration (HR, 0.95; 95% CI, 0.94-0.97; P <.001), and single marital status (HR, 0.43; 95% CI, 0.26-0.73; P <.001).

This study may have been limited by selection bias, and the researchers did not assess patients by type of dementia or verify whether pneumonia was caused by aspiration pneumonia or other indications.

According to the researchers, these findings provide “…evidence to support CHF practices in hospitals and [skilled nursing facilities] not only for quality of life considerations but also demonstrated feasibility and the potential to [decrease the risk for] pneumonia in this population.”


Yuen JK, Luk JKH, Chan T-C, et al. Reduced pneumonia risk in advanced dementia patients on careful hand feeding compared with nasogastric tube feeding. J Am Med Dir Assoc. 2022;S1525-8610(22)00255-9. doi:10.1016/j.jamda.2022.03.011