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Risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africa
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 condition...
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| Format: | Thesis |
| Language: | English |
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Division of Communication Sciences and Disorders
2015
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| _version_ | 1867613312467861504 |
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| access_status_str | Open Access |
| author | Kenny, Nicoll |
| author2 | Singh, Shajila |
| author_browse | Kenny, Nicoll Singh, Shajila |
| author_facet | Singh, Shajila Kenny, Nicoll |
| author_sort | Kenny, Nicoll |
| collection | Thesis |
| description | 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. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/15521 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:34:08.683Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2015 |
| publishDateRange | 2015 |
| publishDateSort | 2015 |
| publisher | Division of Communication Sciences and Disorders |
| publisherStr | Division of Communication Sciences and Disorders |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/15521 Risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africa Kenny, Nicoll Singh, Shajila Speech-Language Pathology 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. 2015-12-03T14:03:36Z 2015-12-03T14:03:36Z 2015 Master Thesis Masters MSc http://hdl.handle.net/11427/15521 eng application/pdf Division of Communication Sciences and Disorders Faculty of Health Sciences University of Cape Town |
| spellingShingle | Speech-Language Pathology Kenny, Nicoll Risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africa |
| thesis_degree_str | Master's |
| title | Risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africa |
| title_full | Risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africa |
| title_fullStr | Risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africa |
| title_full_unstemmed | Risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africa |
| title_short | Risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in South Africa |
| title_sort | risks and outcomes for enteral nutrition among adults with dysphagia at a tertiary level hospital in south africa |
| topic | Speech-Language Pathology |
| url | http://hdl.handle.net/11427/15521 |
| work_keys_str_mv | AT kennynicoll risksandoutcomesforenteralnutritionamongadultswithdysphagiaatatertiarylevelhospitalinsouthafrica |