{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T06:11:12Z","timestamp":1789020672129,"version":"build-2803163510"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005847","name":"Health and Medical Research Fund","doi-asserted-by":"publisher","award":["17181421"],"award-info":[{"award-number":["17181421"]}],"id":[{"id":"10.13039\/501100005847","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Nasogastric tube feeding is commonly used for enteral nutrition in individuals with advanced dementia with feeding difficulties, but its impact on survival and pneumonia risk compared to careful hand feeding remains controversial. This study aimed to compare one-year survival and pneumonia risk in individuals with advanced dementia initiated on nasogastric tube feeding versus those receiving careful hand feeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective propensity score-matched cohort study was conducted. Participants included individuals aged \u226560 years with advanced dementia and feeding problems admitted to two geriatric hospitals between September 2020 and September 2022. Propensity-score matched cohorts were analyzed using Kaplan\u2013Meier survival analysis and Cox proportional hazards regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 283 participants (mean age 89.8 years, 62.2% female, 73.5% residential care home residents), 184 (65.0%) received careful hand feeding, and 99 (35.0%) nasogastric tube feeding. A matched subsample of 176 participants (116 careful hand feeding, 60 nasogastric tube feeding) was analyzed. One-year adjusted survival did not differ significantly between the nasogastric tube feeding and careful hand feeding groups (AHR= 0.85, 95% CI, 0.59-1.23, P = .38). However, the nasogastric tube feeding group had a significantly higher one-year adjusted pneumonia risk compared to the careful hand feeding group (AHR 1.60, 95% CI, 1.06-2.42, P = .03).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Individuals with advanced dementia initiated on nasogastric tube feeding do not have meaningfully improved survival and have a higher risk of pneumonia compared to those receiving careful hand feeding. These findings can guide clinicians and families when considering feeding tube placement for individuals with advanced dementia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/gerona\/glaf165","type":"journal-article","created":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T11:39:15Z","timestamp":1754739555000},"source":"Crossref","is-referenced-by-count":6,"title":["Comparison of survival and pneumonia risk in advanced dementia patients on nasogastric tube feeding versus careful hand feeding"],"prefix":"10.1093","volume":"80","author":[{"given":"Jacqueline K","family":"Yuen","sequence":"first","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, Queen Mary Hospital, The University of Hong Kong , Hong Kong SAR,","place":["China"]},{"name":"School of Public Health, LKS Faculty of Medicine, The University of Hong Kong , Hong Kong SAR,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachelle","family":"Bernacki","sequence":"additional","affiliation":[{"name":"Division of Adult Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix H W","family":"Chan","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, Queen Mary Hospital, The University of Hong Kong , Hong Kong SAR,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuen-Ching","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Medicine and Geriatrics, Fung Yiu King Hospital , Hong Kong SAR,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David T Y","family":"Chow","sequence":"additional","affiliation":[{"name":"Department of Speech Therapy, Grantham Hospital , Hong Kong SAR,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yat-Fung","family":"Shea","sequence":"additional","affiliation":[{"name":"Geriatrics Medical Unit, Grantham Hospital , Hong Kong SAR,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betty L H","family":"Ng","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, Queen Mary Hospital, The University of Hong Kong , Hong Kong SAR,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7114-5739","authenticated-orcid":false,"given":"Karen M K","family":"Chan","sequence":"additional","affiliation":[{"name":"Swallowing Research Laboratory, LKS Faculty of Medicine, The University of Hong Kong , Hong Kong SAR,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4836-7808","authenticated-orcid":false,"given":"Xue","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Clinical Medicine, The University of Hong Kong , Hong Kong SAR,","place":["China"]},{"name":"Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong , Hong Kong SAR,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi-Man","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Clinical Medicine, The University of Hong Kong , Hong Kong SAR,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James K H","family":"Luk","sequence":"additional","affiliation":[{"name":"Department of Medicine and Geriatrics, Fung Yiu King Hospital , Hong Kong SAR,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"2026030304113796900_glaf165-B1","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1016\/S0140-6736(15)01124-1","article-title":"Alzheimer\u2019s disease","volume":"388","author":"Scheltens","year":"2016","journal-title":"Lancet"},{"key":"2026030304113796900_glaf165-B2","doi-asserted-by":"publisher","first-page":"1529","DOI":"10.1056\/NEJMoa0902234","article-title":"The clinical course of advanced dementia","volume":"361","author":"Mitchell","year":"2009","journal-title":"New Engl J Med"},{"key":"2026030304113796900_glaf165-B3","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1093\/ageing\/afx161","article-title":"Dilemmas for guardians of advanced dementia patients regarding tube feeding","volume":"47","author":"Gil","year":"2018","journal-title":"Age Ageing"},{"key":"2026030304113796900_glaf165-B4","doi-asserted-by":"publisher","first-page":"1590","DOI":"10.1111\/jgs.12924","article-title":"American Geriatrics Society feeding tubes in advanced dementia position statement","volume":"62","author":"American Geriatrics Society Ethics Committee and Clinical Practice and Models of Care Committee","year":"2014","journal-title":"J Am Geriatr Soc."},{"key":"2026030304113796900_glaf165-B5","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1111\/j.1741-6612.2011.00537.x","article-title":"Australian and New Zealand Society for Geriatric Medicine. Position statement\u2014dysphagia and aspiration in older people","volume":"30","author":"Australian and New Zealand Society for Geriatric Medicine","year":"2011","journal-title":"Australas J Ageing."},{"key":"2026030304113796900_glaf165-B6","doi-asserted-by":"publisher","first-page":"1052","DOI":"10.1016\/j.clnu.2015.09.004","article-title":"ESPEN guidelines on nutrition in dementia","volume":"34","author":"Volkert","year":"201","journal-title":"Clin Nutr."},{"key":"2026030304113796900_glaf165-B7","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1001\/jama.2016.9374","article-title":"Tube feeding in US nursing home residents with advanced dementia, 2000-2014","volume":"316","author":"Mitchell","year":"2016","journal-title":"JAMA."},{"key":"2026030304113796900_glaf165-B8","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1159\/000265998","article-title":"Prevalence of percutaneous endoscopic gastrostomy in nursing home residents\u2014a nationwide survey in Germany","volume":"56","author":"Wirth","year":"2010","journal-title":"Gerontology"},{"key":"2026030304113796900_glaf165-B9","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1007\/s41999-022-00725-2","article-title":"Medical choices regarding feeding tubes in patients with end-stage dementia in Israel: nasogastric vs. percutaneous endoscopic gastrostomy","volume":"14","author":"Avnon Sawicki","year":"2023","journal-title":"Eur Geriatr Med."},{"key":"2026030304113796900_glaf165-B10","doi-asserted-by":"publisher","first-page":"1748","DOI":"10.3390\/nu14091748","article-title":"Nationwide prevalence and outcomes of long-term nasogastric tube placement in adults","volume":"14","author":"Hsu","year":"2022","journal-title":"Nutrients."},{"key":"2026030304113796900_glaf165-B11","doi-asserted-by":"publisher","first-page":"2492","DOI":"10.3390\/nu11102492","article-title":"Home enteral nutrition in Singapore\u2019s long-term care homes-incidence, prevalence, cost, and staffing","volume":"11","author":"Wong","year":"2019","journal-title":"Nutrients."},{"key":"2026030304113796900_glaf165-B12","doi-asserted-by":"publisher","first-page":"518","DOI":"10.12809\/hkmj133951","article-title":"Mortality and health services utilization among older people with advanced cognitive impairment living in residential care homes","volume":"19","author":"Luk","year":"2013","journal-title":"Hong Kong Med J."},{"key":"2026030304113796900_glaf165-B13","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1093\/gerona\/61.6.621","article-title":"Enteral feeding in end-stage dementia: a comparison of religious, ethnic, and national differences in Canada and Israel","volume":"61","author":"Clarfield","year":"2006","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2026030304113796900_glaf165-B14","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1089\/jpm.2008.0033","article-title":"Physicians\u2019 expectations of benefit from tube feeding","volume":"11","author":"Hanson","year":"2008","journal-title":"J Palliat Med."},{"key":"2026030304113796900_glaf165-B15","doi-asserted-by":"publisher","volume-title":"Supportive and Palliative Care and Quality of Life in Oncology","author":"Anjos","DOI":"10.5772\/intechopen.104509"},{"key":"2026030304113796900_glaf165-B16","doi-asserted-by":"publisher","first-page":"268","DOI":"10.3399\/bjgp25X742557","article-title":"Enteral feeding for patients with dementia: an ethical critique of the clinical and economic considerations","volume":"75","author":"Faggion","year":"2025","journal-title":"Br J Gen Pract."},{"key":"2026030304113796900_glaf165-B17","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1046\/j.1532-5415.2003.51364.x","article-title":"Ethical issues in end-of-life geriatric care: the approach of three monotheistic religions-Judaism, Catholicism, and Islam","volume":"51","author":"Clarfield","year":"2003","journal-title":"J Am Geriatr Soc."},{"key":"2026030304113796900_glaf165-B18","doi-asserted-by":"publisher","first-page":"306","DOI":"10.12809\/hkmj166110","article-title":"The feeding paradox in advanced dementia: a local perspective","volume":"23","author":"Luk","year":"2017","journal-title":"Hong Kong Med J."},{"key":"2026030304113796900_glaf165-B19","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1007\/s12603-023-1926-9","article-title":"Hospital careful hand feeding program reduced feeding tube use in patients with advanced dementia","volume":"27","author":"Yuen","year":"2023","journal-title":"J Nutr Health Aging"},{"key":"2026030304113796900_glaf165-B20","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1111\/dewb.12239","article-title":"Cultural considerations in forgoing enteral feeding: a comparison between the Hong Kong Chinese, North American, and Malaysian Islamic patients with advanced dementia at the end-of-life","volume":"20","author":"Ngan","year":"2020","journal-title":"Dev World Bioeth."},{"key":"2026030304113796900_glaf165-B21","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1111\/j.1365-2648.2007.04230.x","article-title":"The attitudes of Chinese family caregivers of older people with dementia towards life sustaining treatments","volume":"58","author":"Kwok","year":"2007","journal-title":"J Adv Nurs."},{"key":"2026030304113796900_glaf165-B22","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.1016\/j.clnu.2016.04.019","article-title":"Systematic review of qualitative and quantitative studies on the attitudes and barriers to percutaneous endoscopic gastrostomy feeding","volume":"35","author":"Jaafar","year":"2016","journal-title":"Clin Nutr."},{"key":"2026030304113796900_glaf165-B23","doi-asserted-by":"publisher","first-page":"802","DOI":"10.1111\/j.1365-2702.2010.03541.x","article-title":"A survey of the reasons patients do not chose percutaneous endoscopic gastrostomy\/jejunostomy (PEG\/PEJ) as a route for long-term feeding","volume":"20","author":"Lin","year":"2011","journal-title":"J Clin Nurs"},{"key":"2026030304113796900_glaf165-B24","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1111\/jhn.12908","article-title":"The experience of family caregivers of patients receiving home nasogastric tube feeding in China: a descriptive qualitative study","volume":"35","author":"Xue","year":"2022","journal-title":"J Hum Nutr Diet."},{"key":"2026030304113796900_glaf165-B25","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s41043-021-00264-9","article-title":"Clinician\u2019s attitude to enteral nutrition with percutaneous endoscopic gastrostomy: a survey in China","volume":"40","author":"Zhang","year":"2021","journal-title":"J Health Popul Nutr"},{"key":"2026030304113796900_glaf165-B26","doi-asserted-by":"publisher","first-page":"CD013503","DOI":"10.1002\/14651858.CD013503.pub2","article-title":"Enteral tube feeding for people with severe dementia","volume":"8","author":"Davies","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"2026030304113796900_glaf165-B27","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1016\/j.jamda.2020.06.035","article-title":"The efficacy and safety of tube feeding in advanced dementia patients: a systemic review and meta-analysis study","volume":"22","author":"Lee","year":"2021","journal-title":"J Am Med Dir Assoc"},{"key":"2026030304113796900_glaf165-B28","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s12877-020-1464-9","article-title":"Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison","volume":"20","author":"Chou","year":"2020","journal-title":"BMC Geriatr"},{"key":"2026030304113796900_glaf165-B29","doi-asserted-by":"publisher","first-page":"1918","DOI":"10.1111\/j.1532-5415.2012.04148.x","article-title":"Does feeding tube insertion and its timing improve survival?","volume":"60","author":"Teno","year":"2012","journal-title":"J Am Geriatr Soc"},{"key":"2026030304113796900_glaf165-B30","volume-title":"HA Guidelines on Life-Sustaining Treatment in the Terminally Ill. 2015.","year":"2015"},{"key":"2026030304113796900_glaf165-B31","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1016\/j.jamda.2008.10.010","article-title":"Natural history of feeding-tube use in nursing home residents with advanced dementia","volume":"10","author":"Kuo","year":"2009","journal-title":"J Am Med Dir Assoc"},{"key":"2026030304113796900_glaf165-B32","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1001\/archinte.161.4.594","article-title":"High short-term mortality in hospitalized patients with advanced dementia: lack of benefit of tube feeding","volume":"161","author":"Meier","year":"2001","journal-title":"Arch Intern Med"},{"key":"2026030304113796900_glaf165-B33","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1016\/j.jpainsymman.2012.02.007","article-title":"Do patients with advanced cognitive impairment admitted to hospitals with higher rates of feeding tube insertion have improved survival?","volume":"45","author":"Cai","year":"2013","journal-title":"J Pain Symptom Manag"},{"key":"2026030304113796900_glaf165-B34","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1016\/j.jamda.2022.03.011","article-title":"Reduced pneumonia risk in advanced dementia patients on careful hand feeding compared with nasogastric tube feeding","volume":"23","author":"Yuen","year":"2022","journal-title":"J Am Med Dir Assoc"},{"key":"2026030304113796900_glaf165-B35","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1017\/s1041610292001157","article-title":"Functional assessment staging (FAST) in Alzheimer\u2019s disease: reliability, validity, and ordinality","volume":"4","author":"Sclan","year":"1992","journal-title":"Int Psychogeriatr"},{"key":"2026030304113796900_glaf165-B36","doi-asserted-by":"publisher","first-page":"303","DOI":"10.14283\/jfa.2020.50","article-title":"Letter to the editor: careful hand feeding program in a geriatric step-down hospital in Hong Kong\u2014is this feasible?","volume":"10","author":"Luk","year":"2021","journal-title":"J Frailty Aging"},{"key":"2026030304113796900_glaf165-B37","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1080\/00273171.2011.568786","article-title":"An introduction to propensity score methods for reducing the effects of confounding in observational studies","volume":"46","author":"Austin","year":"2011","journal-title":"Multivariate Behav Res"},{"key":"2026030304113796900_glaf165-B38","doi-asserted-by":"publisher","first-page":"1218","DOI":"10.1002\/pds.1674","article-title":"Assessing balance in measured baseline covariates when using many-to-one matching on the propensity-score","volume":"17","author":"Austin","year":"2008","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2026030304113796900_glaf165-B39","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/s12874-017-0338-0","article-title":"Double-adjustment in propensity score matching analysis: choosing a threshold for considering residual imbalance","volume":"17","author":"Nguyen","year":"2017","journal-title":"BMC Med Res Methodol"},{"key":"2026030304113796900_glaf165-B40","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1002\/gps.1299","article-title":"Survival of a cohort of elderly patients with advanced dementia: nasogastric tube feeding as a risk factor for mortality","volume":"20","author":"Alvarez-Fernandez","year":"2005","journal-title":"Int J Geriatr Psychiatry."},{"key":"2026030304113796900_glaf165-B41","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1111\/psyg.12623","article-title":"Poor feeding due to visitor restrictions in long-term care facilities during the coronavirus disease 2019 pandemic","volume":"20","author":"Shum","year":"2020","journal-title":"Psychogeriatrics"},{"key":"2026030304113796900_glaf165-B42","author":"Center for Health Protection","year":"2020"},{"key":"2026030304113796900_glaf165-B43","doi-asserted-by":"publisher","first-page":"2969","DOI":"10.3390\/nu11122969","article-title":"Percutaneous endoscopic gastrostomy versus nasogastric tube feeding: oropharyngeal dysphagia increases risk for pneumonia requiring hospital admission","volume":"11","author":"Chang","year":"2019","journal-title":"Nutrients."},{"key":"2026030304113796900_glaf165-B44","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.jstrokecerebrovasdis.2011.07.008","article-title":"Gastroesophageal reflux during enteral feeding in stroke patients: a 24-hour esophageal pH-monitoring study","volume":"22","author":"Satou","year":"2013","journal-title":"J Stroke Cerebrovasc Dis."},{"key":"2026030304113796900_glaf165-B45","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1097\/01.mco.0000068970.34812.8b","article-title":"The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia","volume":"6","author":"Gomes","year":"2003","journal-title":"Curr Opin Clin Nutr Metab Care."}],"container-title":["The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/biomedgerontology\/advance-article-pdf\/doi\/10.1093\/gerona\/glaf165\/64017498\/glaf165.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/biomedgerontology\/article-pdf\/80\/9\/glaf165\/64017498\/glaf165.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/biomedgerontology\/article-pdf\/80\/9\/glaf165\/64017498\/glaf165.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T09:14:54Z","timestamp":1772529294000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/biomedgerontology\/article\/doi\/10.1093\/gerona\/glaf165\/8231674"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,20]]},"references-count":45,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,8,23]]}},"URL":"https:\/\/doi.org\/10.1093\/gerona\/glaf165","relation":{},"ISSN":["1079-5006","1758-535X"],"issn-type":[{"value":"1079-5006","type":"print"},{"value":"1758-535X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,9]]},"published":{"date-parts":[[2025,8,20]]},"article-number":"glaf165"}}