Risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africa

 

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dc.contributor.advisor Singh, Shajila en_ZA
dc.contributor.author Kenny, Nicoll en_ZA
dc.date.accessioned 2015-12-03T14:03:36Z
dc.date.available 2015-12-03T14:03:36Z
dc.date.issued 2015 en_ZA
dc.identifier.citation Kenny, N. 2015. Risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africa. University of Cape Town. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/15521
dc.description.abstract Patients with dysphagia, who are unable to meet their daily hydration and nutritional needs orally, may require enteral nutrition, either via a nasogastric tube (NGT) as a short term provision, or via a gastrostomy tube for longer term provision. The presence of dysphagia, specific medical conditions and the presence of comorbidities place patients, who require enteral nutrition, at risk for mortality. High rates of mortality are reported in international literature, in patients following the placement of long term enteral nutrition via percutaneous endoscopic gastrostomy (PEG). High mortality rates following the placement of enteral nutrition in patients treated by Speech Language Therapists (SLTs) at Chris Hani Baragwanath Academic Hospital (CHBAH) were noted anecdotally. No study has previously been done to analyse the outcomes and risks of the placement of enteral nutrition in the adult population with dysphagia in the South African context. This study aimed to compare survival times in patients with dysphagia, who had a single morbidity and multiple morbidities, who were recommended for enteral nutrition to those who were recommended for oral palliative nutrition, and the risks associated with a higher risk of mortality postplacement of enteral nutrition. Design: The study employed an observational cohort design, using both retrospective and prospective methods. Three cohorts were included in the study.1) Participants with multiple morbidities who were recommended for enteral nutrition (n=212), 2) Participants with a single morbidity who were recommended for enteral nutrition (n=35) and, 3) Participants who were placed on oral palliative nutrition (n=10). Results: A high rate or mortality was noted in all participants who were placed on enteral nutrition (regardless of it being NGT or PEG). Survival time was longer in participants with a single morbidity (54 days) compared to those with multiple morbidities (24 days) who received a PEG. Survival of participants with multiple morbidities who were on oral palliative nutrition, was only five days less (19 days) than participants with multiple morbidities who had a PEG placed. Mortality rates were high following the placement of enteral nutrition which could be attributed to the participants underlying medical condition and level of morbidities present. Conclusion: Findings of this study highlight the need for greater consideration of the risk factors that may place a patient at risk of mortality following the placement of enteral nutrition. It brings into question the futility of some PEG procedures in a cohort of participants that show such poor survival, and encourages clinicians to explore the option of oral palliative nutrition as a recommendation for patients who are expected to have a high risk of mortality if recommended for and placed with enteral nutrition. en_ZA
dc.language.iso eng en_ZA
dc.subject.other Speech-Language Pathology en_ZA
dc.title Risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africa en_ZA
dc.type Master Thesis
uct.type.publication Research en_ZA
uct.type.resource Thesis en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Division of Communication Sciences and Disorders en_ZA
dc.type.qualificationlevel Masters
dc.type.qualificationname MSc en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Kenny, N. (2015). <i>Risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africa</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Division of Communication Sciences and Disorders. Retrieved from http://hdl.handle.net/11427/15521 en_ZA
dc.identifier.chicagocitation Kenny, Nicoll. <i>"Risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africa."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Division of Communication Sciences and Disorders, 2015. http://hdl.handle.net/11427/15521 en_ZA
dc.identifier.vancouvercitation Kenny N. Risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africa. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Division of Communication Sciences and Disorders, 2015 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/15521 en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Kenny, Nicoll AB - Patients with dysphagia, who are unable to meet their daily hydration and nutritional needs orally, may require enteral nutrition, either via a nasogastric tube (NGT) as a short term provision, or via a gastrostomy tube for longer term provision. The presence of dysphagia, specific medical conditions and the presence of comorbidities place patients, who require enteral nutrition, at risk for mortality. High rates of mortality are reported in international literature, in patients following the placement of long term enteral nutrition via percutaneous endoscopic gastrostomy (PEG). High mortality rates following the placement of enteral nutrition in patients treated by Speech Language Therapists (SLTs) at Chris Hani Baragwanath Academic Hospital (CHBAH) were noted anecdotally. No study has previously been done to analyse the outcomes and risks of the placement of enteral nutrition in the adult population with dysphagia in the South African context. This study aimed to compare survival times in patients with dysphagia, who had a single morbidity and multiple morbidities, who were recommended for enteral nutrition to those who were recommended for oral palliative nutrition, and the risks associated with a higher risk of mortality postplacement of enteral nutrition. Design: The study employed an observational cohort design, using both retrospective and prospective methods. Three cohorts were included in the study.1) Participants with multiple morbidities who were recommended for enteral nutrition (n=212), 2) Participants with a single morbidity who were recommended for enteral nutrition (n=35) and, 3) Participants who were placed on oral palliative nutrition (n=10). Results: A high rate or mortality was noted in all participants who were placed on enteral nutrition (regardless of it being NGT or PEG). Survival time was longer in participants with a single morbidity (54 days) compared to those with multiple morbidities (24 days) who received a PEG. Survival of participants with multiple morbidities who were on oral palliative nutrition, was only five days less (19 days) than participants with multiple morbidities who had a PEG placed. Mortality rates were high following the placement of enteral nutrition which could be attributed to the participants underlying medical condition and level of morbidities present. Conclusion: Findings of this study highlight the need for greater consideration of the risk factors that may place a patient at risk of mortality following the placement of enteral nutrition. It brings into question the futility of some PEG procedures in a cohort of participants that show such poor survival, and encourages clinicians to explore the option of oral palliative nutrition as a recommendation for patients who are expected to have a high risk of mortality if recommended for and placed with enteral nutrition. DA - 2015 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africa TI - Risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africa UR - http://hdl.handle.net/11427/15521 ER - en_ZA


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