The inability to eat independently is a hallmark of advanced dementia. There is a high prevalence of artificial feeding in Hong Kong due to the interplay of cultural factors and lack of advance care planning. The government introduced the Advanced Decision on Life-sustaining Treatment Ordinance in 2024 to promote artificial feeding alternatives. A CHF program was piloted in North District Hospital in early 2025. A multidisciplinary approach was adopted, with involvement of geriatricians, nurses, speech therapists, dieticians, physiotherapists, patient-care assistants and the community geriatric assessment team. 11 patients were recruited with an average age of 88.7 years old. 7 (63.6%) suffered from advanced dementia with 4 (36.4%) being terminally ill. The primary reason for initiation of CHF was dysphagia. Caregivers received one-to-one education from the speech therapist in all cases. 4 (36.3%) died and 7 (63.6%) were discharged from the index admission. All discharged patients had follow-up by the community geriatric and speech therapist team while 5 (71.4%) were not readmitted at the time of study. Preliminary results suggest a multidisciplinary approach with involvement of caregiver and community resources may be effective in changing artificial feeding practices, overcoming the challenges of sustainability, while without increasing hospital readmission rates. Large population and longer follow-up are needed to determine the program’s efficacy.

Authors:
Justin Ming Zheng Ma, North District Hospital, Hong Kong
Lok Ling Leung, North District Hospital, Hong Kong
Wai Kwan Wong, North District Hospital, Hong Kong

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Posted by James Alexander Gordon

Last updated: 2023-02-23 23:45:00

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