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

Simple item page
dc.contributor.advisorSingh, Shajilaen_ZA
dc.contributor.authorKenny, Nicollen_ZA
dc.date.accessioned2015-12-03T14:03:36Z
dc.date.available2015-12-03T14:03:36Z
dc.date.issued2015en_ZA
dc.description.abstractPatients 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.identifier.apacitationKenny, 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/11427/15521en_ZA
dc.identifier.chicagocitationKenny, 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/11427/15521en_ZA
dc.identifier.citationKenny, 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.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
dc.identifier.urihttp://hdl.handle.net/11427/15521
dc.identifier.vancouvercitationKenny 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/11427/15521en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDivision of Communication Sciences and Disordersen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherSpeech-Language Pathologyen_ZA
dc.titleRisks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africaen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMScen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
thesis_hsf_2015_kenny_nicoll (1).pdf
Size:
3.08 MB
Format:
Adobe Portable Document Format
Description:
Download
Collections
Masters