Year

2024

Season

Spring

Paper Type

Doctoral Dissertation

College

Brooks College of Health

Degree Name

Doctor of Clinical Nutrition (DCN)

Department

Nutrition & Dietetics

NACO controlled Corporate Body

University of North Florida. Department of Nutrition & Dietetics

First Advisor

Dr. Casey Colin, DCN, RDN, LD/N, FAND

Second Advisor

Dr. Lauri Wright, PhD, RDN, LD/N, FAND

Third Advisor

Dr. Sherri Lewis, DCN, RDN, LD/N, FAND

Department Chair

Jen Ross, DCN, RD, LDN, FAND

College Dean

Mei Zhao, PhD

Abstract

Background: People who directly served in the naval, military, or air service and were discharged or released in honorable condition are at higher risk of developing dementia. Dementia is a brain disorder that can interfere with daily activities such as eating, resulting in inadequate oral intake. In such cases, a G-tube may be considered. However, it's challenging to decide whether tube feeding should be recommended due to the lack of evidence regarding its benefits and risks in individuals with advanced dementia. The purpose of the study was to analyze the impact of G-tube placement on the survival, hospital readmission, pressure injury incidence, and mortality of Veterans with dementia. A secondary aim of the study was to evaluate the difference in swallowing levels between the patients with G-tubes and those without G-tubes.

Methods: The study analyzed 34 dementia patients who had a G-tube consult in place and underwent a swallowing evaluation of level 6 or less in the past 7 years. Fisher's exact statistical test was used to compare the outcomes of patients with and without a G-tube in terms of 30-day mortality, 30-day development of pressure injury stage one or higher, and 30-day readmission. The study also used the Mann-Whitney test to evaluate swallowing level differences. Additionally, Cox proportional hazards regression model was employed to determine the correlation between survival time in Veterans with dementia with G-tubes compared with those without a tube.

Results: Patients with G-tubes had a lower mean swallow function level of 5, whereas those without tubes had a mean of 6. G-tube did not significantly affect the mortality rate, but 12.5% of patients with G-tubes experienced mortality within 30 days compared to 16.7% of patients without G-tubes. Patients with G-tubes exhibited a pressure injury incidence rate of 31.3% compared with 11.2% in the no G-tube group. The readmission rate was 12.5% for patients with G-tubes, which is higher than the rate of 0% among those without G-tubes. The average survival duration for patients with G-tubes was 763 ± 766.6 days.

Conclusion: The study found that G-tube placement may not provide any significant benefit to patients with dementia. This research is important as Veterans have a higher risk of developing dementia and understanding the prevalence and outcomes of G-tube usage can help healthcare providers inform caregivers about the disease process early in the stage.

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Available for download on Monday, April 30, 2029

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