Jennifer Celtrick

Thursday 9-12
1

What is The Best Way to Nourish a Dementia Patient?

Jennifer Celtrick, SN
Jackson College

Jennifer Celtrick
Thursday 9-12
2

Answers for EBN PICOT

1. Write a PICOT statement based on patient care or unit practices you have

experienced during your clinical days in the Jackson College Nursing Program. (Get
approval for the PICOT statement from faculty before proceeding.)
What is the best way to nourish a dementia patient?
Population- Adults 50+
Intervention or issue of interest- Best method of providing nutrition to
patients with dementia
Comparison intervention group- Any; Clinical trial, randomized controlled
or non -controlled trial, Systemic Review, Meta-analysis, and Evidenced
based clinical guidelines
Outcome- Improved quality of life and/or best end of life care decision
Time Frame- Varies- course of illness is different for each patient

2. What type of PICOT statement is this? (Refer to PICOT Types of evidence for this

question and also #3, 4 & 6)

Therapy

3. What is the best type of evidence to answer this question?

Clinical trial
Randomized controlled or non -controlled trial
Systemic Review
Meta-analysis
Evidenced based clinical guidelines

NOTE: Questions 4-6 can include both full text and abstract only sources. However,
questions 7-9 need to consider only full text sources in the response.

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Thursday 9-12
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3. Search for the best evidence reflecting the highest level of evidence available.
1. If your initial search does not yield results or you have too many results,
refine your PICOT or search terms.
2. If your search still has no results, go to a different, more appropriate
database.
3. You may use up to three databases in order to get a successful search.
After three, document your findings and move on. (If you get sufficient and
good results in your first database, you do not have to use 3 different
databases but need to use up to 3 to get good results.)
4. Most sources should be < 5 years old unless there is no more recent data
& it is highly relevant to your topic.
5. If you are struggling & spending more than 90 minutes on your search,
contact a reference librarian or one of your classroom faculty.
Name the database
you used.

#1
CINHAL

List search terms you tried

first & your final revisions:

First terms:
Dementia and nutrition

How many hits did

you get from your final
search on this
database?
118

Final terms:
Dementia and feeding

#2
(Only use a 2nd or 3rd
data base if you dont
have a good response
in your 1st one)
Medline

First terms:
Dementia and food

Final terms:
Dementia and feeding

260

Jennifer Celtrick
Thursday 9-12
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#3

First terms:

Final terms:

5. Look at your top 10 most relevant & pertinent findings from your best search. Using
the full text or abstract, indicate how many of each you found in each category?

Systematic Review from RCT _1_________

Meta-Analysis from RCT __2________

EB Clinical Practice Guideline based on Systematic Reviews of RCT

_2_________

RCT (well designed) ____3______

Controlled Trial Non-Randomization (well designed) __3________

Case Control or Cohort Studies (well designed) __________

Systematic Reviews of Descriptive or Qualitative Studies __________

Single Descriptive or Qualitative Study __________

Opinion of Authorities &/or Reports of Expert Committees _________

Other: __________ (Describe)

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Thursday 9-12
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6. Based on your analysis in question #5, rate the evidence that you found using the
PICOT level of evidence.
HIGH

MEDIUM

LOW

(circle one)

Most evidence level 1-3

7. Select at least 3 full text sources that you found for your PICOT. Either attach copies
of them or list the complete citation or URL so that your classroom faculty can easily
find the documents and go to them directly.
Assisted Oral Feeding and Tube Feeding. (2011, September 1). Retrieved November
14, 2015, from
http://www.alz.org/documents_custom/statements/Assisted_Oral_Tube_Feeding
Daniel, PhD, RN, K., Rhodes, MD, MPH, MSCS, R., Vitale, MD, C., & Shega, MD, J.
(2014). American Geriatrics Society Feeding Tubes in Advanced Dementia Position
Statement. Journal of the American Geriatrics Society J Am Geriatr Soc, 62(8), 15901593. doi:10.1111/jgs.12924
Hanson, L., Ersek, M., Gilliam, R., & Carey, T. (n.d.). Oral Feeding Options for People
with Dementia: A Systematic Review. Journal of the American Geriatrics Society, 59(3),
463-472. doi:10.1111/j.1532-5415.2011.03320.x
Rose, K., & Lopez, R. (2012). Transitions in Dementia Care: Theoretical Support for
Nursing Roles. OJIN: The Online Journal of Issues in Nursing, 17(2).
doi:10.3912/OJIN.Vol17No02Man04
Schwartz, D., Barrocas, A., Wesley, J., Kliger, G., Pontes-Arruda, A., Marquez, H., . . .
Ditucci, A. (2014). Gastrostomy Tube Placement in Patients With Advanced Dementia or
Near End of Life. Nutrition in Clinical Practice, 829-840.
doi:10.1177/0884533614546890

8. Summarize the findings from your search and whether or not it is applicable to your
PICOT. How does the information you found answer (or not answer) the question
that you had?
I found the tube feeding policy for Allegiance Health and it does not specifically
mention patients with dementia but my research answered my question. Tube
feedings are not recommended for patients with dementia because once dysphagia

Jennifer Celtrick
Thursday 9-12
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is present, which it is in about 80%, the disease is at the advanced stage and these
patients upwards of 30 to 40 percent pass around the one month mark of placement
of an invasive tube i.e. peg tube.

The risk of aspiration was the same for oral and tube feedings. Also the amount
of nutrition and hydration did not vary greatly. Tube feedings resulted in agitation and
stress for the patient and increased the use of physical and chemical restraints and
did not show to reduce the risk of pressure ulcers developing. Patients with oral
feedings did gain some weight.

The recommendations going forward are to orally feed patients for as long as
possible with high nutritional value supplements. This promotes dignity and bonding
between patient and caregiver, who most often is a family member, and for
modification of environment to reduce stimulation and promote successful hand
feeding. If a feeding tube is recommended, that it is done so as a trial basis and that
to educate the family or primary caregiver about the current evidence, that risks
outweigh the benefits, and that dementia is a terminal illness.

9. If you were a staff nurse who had completed this search, fully describe what next
steps you would consider after completing the search. Describe what practice
changes might be indicated. How might patient/family preferences influence
implementation? How would you go about recommending or implementing a change
in practice?

Jennifer Celtrick
Thursday 9-12
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If your search did not yield good results, discuss the consequences of not being able
to answer your PICOT and what follow-up would be appropriate if you had this
question as a nurse in practice.
Be very specific and detailed in answering this question.
Tube feedings and the need for one vary from case to case. Cultural views on
feeding plays a role. Food and meal time can be anywhere from social to intimate.
People may even feel guilty about withholding food and hydration from someone
who is dying. To institute a facility wide policy on not tubing someone for food and
hydration with dementia would be very difficult for those for mentioned reasons.

Education would be the best avenue. Inform the family or primary care giver that
oral feedings provide the best health promotion and that at the advanced stages a
trial tube feeding would be better approach but educate that it is not recommended
and why. Also better education in regards to dementia, such as Alzheimers, is a
terminal illness and that when dysphagia presents the disease is in the advance
stages and the patient is most likely entering the dying process.