Good Example Of Research Paper On Meeting The Feeding Needs For Advanced Stage Dementia Patients (African American In Tristate Area) In The Nursing Home Population

Phase I: Introduction Dementia is an illness that continually affects many families. Due to the need for intensive care, especially for patients with advanced state dementia, many families opt for nursing homes. Nursing homes can offer the much need care and attention to the needs of the patient. Nursing homes also offer skilled end-of-life care for the patients, hence the choice of the option for many families. As a nurse, I have a profession interest in the care of patients with advanced stage dementia. My interest is fueled by the need to ensure that people with advance stage dementia still lead a quality life until the point of death. Feeding is important in the improvement of quality of life for patients with dementia. However, advanced stage dementia commonly causes feeding problems that are at times manifested through difficulties in swallowing. The incompetence of the patient in decision making forces physicians to consider the use of artificial nutrition, for instance, the use of enteral tubes in order to meet the nutritional needs of such patients. The clinical problem, in this case, is the efficacy of these artificial nutritional methods in meeting the nutritional needs and improving the quality of life for patients with advanced stage dementia (Palecek, 2010) In determining the efficacy of these methods in improving the quality of life, it is imperative that any claims are based on evidence. According to Sampson, Candy & Jones (2009), there is no evidence that the use of enteral tube feeding increase the survival rate of patients with advance stage dementia. Despite finding from these studies, enteral tube feeding is used an intervention to meet the nutritional needs of patients with advanced stage dementia. Based on this, the paper explores the subjected under the guidance of the following PICO question:In patients with advance stage dementia, does the use of enteral tube feeding compared to withholding the tube, increase the survival of patients?Phase II: Validation Various scholars have taken different takes on the issue of meeting the feeding needs of patients who are diagnosed with advanced stage dementia. Sampson, Candy & Jones (2009) acknowledge the common practice of using enteral tube feeding for patients who are diagnosed with advanced stage dementia and have labored or poor nutritional intake. In fact, Sampson, Candy & Jones (2009) argue that 34% of the 186,835 residents in nursing homes who had advanced cognitive impairment, the general category under which dementia is classified, were fed using enteral feeding tubes. Even with this high usage of this artificial feeding approach, the harms or benefits of the practice are largely unclear. In order to further explore this issue, Sampson, Candy & Jones (2009) performed a meta-analysis of studies exploring the use of enteral feeding in patients with advanced stage dementia. The aim of this meta-analysis was to evaluate the outcomes of the use of enteral feeding in patients with advanced dementia, especially when the patients manifested poor nutritional intake. The primary outcomes that were considered in the analysis were the improvement in the quality of life and survival. The analysis found that the patients who were fed using enteral tubes did not show evidence of increase survival. The analysis also did not show any improvements in the nutritional status owing to the use of enteral feeding. The results of this study have dire implications on the research topic. The fact that the meta-analysis did not find any improvements in the nutritional status of the patients has a bearing on the efficacy of the use of enteral feeding in patients with advanced stage dementia. The implication of this is that even if the feeding approach is used extensively in nursing homes, it is not based on evidence of its efficacy. As highlighted above, different scholars have taken different stands on the efficacy of the use of tube feeding in patients with advanced stage dementia. Mitchell, Teno & Kiely (2009) performed a prospective study using residents of nursing home who were diagnosed with advanced stage dementia. The study showed a very high 6-month mortality rate (38.6%) of those patients who had problems feeding. During the final three months that these patients were projected to live, close to 8% of the patients were fitted with feeding tubes. Of the patients who were fitted with feeding tubes, 40% experienced further burdensome interventions in this period. The results are important in understanding the efficacy of enteral feeding in meeting the feeding needs of patients with advanced stage dementia. The adequacy of feeding is shown by a change in the nutritional status. The fact that 40% of the patients who were fitted with feeding tubes experience burdensome interventions has an effect on their nutritional status (Mitchell, Teno & Kiely, 2009). In considering the efficacy of enteral feeding in meeting the nutritional requirement of patients with advanced stage dementia, it is imperative to consider the propensity for complications, and the effect of these complications on the nutritional status of the patients. According to Gillick (2000), the placement of feeding tubes in patients with advanced stage dementia impairs the quality of life. This has an implication on the feeding of these patients. The medical rate of complications in patients with advanced stage dementia who are fitted with feeding tubes is between 32% and 70%. At the time the feeding tube is placed, and the use of tube feeding in patients with advanced dementia is potentially problematic. Gillick (2000) found that some of the potential problems and complications that had a bearing on the nutritional status of the patients included vomiting, chronic nausea, infections, and bleeding. These are problems that affect the ability of the patient to either take in the food or retain the food for digestion and absorption. For instance chronic nausea and vomiting limit the retention of food by the patient. There are also ongoing complications that affect the nutritional status of the patient. Some of these issues include ulceration and dislodgement of the tube. In this study, Gillick (2000) concluded that the use of enteral feeding tubes does not exacerbate mortality or provided increase survival benefit when the intervention is compared to the control, which, in this case, is withholding a tube.Conclusion The PICO question that guides the review of the literature in this paper was whether the use of enteral tube feeding compared to withholding the tube, increased the survival of patients. The review of the literature has showed that there is very little empirical evidence to support the use of enteral feeding to meet the nutritional needs of patients with advance stage dementia. In fact, studies have shown that there is not nutritional benefit in the use of enteral feeding as far as the nutritional status of the patient is concerned. The review of the literature has also shown that enteral feeding does not bestow any survival benefit for patients with advance stage dementia. Owing to these findings, it is imperative to further explore the issue in order to solve the clinical problem it presents.

References

Gillick, M. (2000). Rethinking the role of tube feeding in patients with advanced dementia. New England Journal of Medicine; 342:206-210.
Mitchell, S, Teno, J. Kiely, D. (2009). The clinical course of advanced dementia. New England Journal of Medicine.; 361:1529-1538.
Palecek, E., Teno J., Casarett, D., Hanson, L., Rhodes, R., Mitchell, S. (2010). Comfort feeding only: a proposal to bring clarity to decision-making regarding difficulty with eating for persons with advanced dementia. Journal of American Geriatric Society. 58:580-584.
Sampson, E., Candy, B. and Jones, L. (2009). Enteral tube feed for older people with advanced dementia. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD007209. DOI: 10.1002/14651858.C D007209.pub2