Navigating dementia feeding decisions in Asia: a mixed methods study of caregivers.

IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Age and ageing Pub Date : 2024-10-01 DOI:10.1093/ageing/afae232
Ellie B Andres, Isha Chaudhry, Ishwarya Balasubramanian, Louisa Poco, Philip Yap, Chetna Malhotra
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Abstract

Background: Tube feeding is discouraged among older adults with advanced dementia; nevertheless, caregivers often find feeding decisions challenging to navigate.

Aim: This study aims to gain a comprehensive understanding of tube feeding among community-dwelling older adults with advanced dementia in Singapore and its relationship to older adult quality of life (QoL) and caregiver psychological distress.

Methods: We use a convergent mixed-methods design, synthesising analysis of qualitative caregiver interviews (n = 25) and two-year prospective, longitudinal cohort survey data (n = 215, 1018 observations).

Results: Findings from the qualitative interviews revealed caregivers' expectations of reduced QoL for older adults with feeding tubes and their own distress related to making feeding decisions and fears prompting plans to tube-feed. Sixteen percent of community-dwelling older adults with advanced dementia relied on feeding tubes during the two-year study period. Adjusting for potential confounding and using instrumental variables estimation, tube feeding was associated with reduced older adult QoL (P < .05) and increased caregiver anxiety and depression (P < .10).

Conclusion: Consistent with expert guidelines, we found that tube feeding was associated with significantly reduced QOL among older adults living with dementia and increased distress among caregivers relative to those of older adults without feeding tubes. Despite caregivers' recognition of reduced QOL associated with older adult use of feeding tubes, many expressed angst related to feeding choices. Our findings suggest the need for decision tools to support caregivers in making informed decisions concordant with their values.

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亚洲痴呆症喂养决策导航:对护理人员的混合方法研究。
背景:目的:本研究旨在全面了解新加坡社区居住的晚期痴呆症老年人的管饲情况及其与老年人生活质量(QoL)和照顾者心理压力之间的关系:我们采用了一种融合的混合方法设计,综合分析了对护理人员的定性访谈(n = 25)和为期两年的前瞻性纵向队列调查数据(n = 215,1018 次观察):定性访谈的结果显示,护理人员预期插管喂养的老年人的生活质量会下降,他们自己在做出喂养决定时也会感到痛苦,担心插管喂养的计划会失败。在为期两年的研究期间,社区居住的晚期痴呆症老年人中有 16% 需要依靠喂食管喂食。在对潜在的混杂因素进行调整并使用工具变量估算后,插管喂养与老年人生活质量下降有关(P 结论:插管喂养与老年人生活质量下降有关:与专家指南一致,我们发现与未使用喂食管的老年人相比,使用喂食管喂食与痴呆症老年人的 QOL 显著下降以及护理人员的痛苦增加有关。尽管照护者认识到老年人使用喂食管会降低其生活质量,但许多照护者对喂食选择表示焦虑。我们的研究结果表明,需要有决策工具来支持护理者做出符合其价值观的明智决定。
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来源期刊
Age and ageing
Age and ageing 医学-老年医学
CiteScore
9.20
自引率
6.00%
发文量
796
审稿时长
4-8 weeks
期刊介绍: Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.
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