BACKGROUND Tube feeding is discouraged among older adults with advanced dementia; nevertheless, caregivers often find feeding decisions challenging to navigate. AIM This study aims to gain a comprehensive understanding of tube feeding among community-dwelling older adults with advanced dementia in Singapore and its relationship to older adult quality of life (QoL) and caregiver psychological distress. METHODS We use a convergent mixed-methods design, synthesising analysis of qualitative caregiver interviews (n = 25) and two-year prospective, longitudinal cohort survey data (n = 215, 1018 observations). RESULTS Findings from the qualitative interviews revealed caregivers' expectations of reduced QoL for older adults with feeding tubes and their own distress related to making feeding decisions and fears prompting plans to tube-feed. Sixteen percent of community-dwelling older adults with advanced dementia relied on feeding tubes during the two-year study period. Adjusting for potential confounding and using instrumental variables estimation, tube feeding was associated with reduced older adult QoL (P < .05) and increased caregiver anxiety and depression (P < .10). CONCLUSION Consistent with expert guidelines, we found that tube feeding was associated with significantly reduced QOL among older adults living with dementia and increased distress among caregivers relative to those of older adults without feeding tubes. Despite caregivers' recognition of reduced QOL associated with older adult use of feeding tubes, many expressed angst related to feeding choices. Our findings suggest the need for decision tools to support caregivers in making informed decisions concordant with their values.

中文翻译：

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在亚洲导航痴呆喂养决策：照顾者的混合方法研究。


背景 不鼓励患有晚期痴呆的老年人进行管饲;然而，护理人员经常发现喂养决定难以驾驭。目的 本研究旨在全面了解新加坡社区晚期痴呆老年人的管饲及其与老年人生活质量 （QoL） 和照顾者心理困扰的关系。方法 我们使用收敛的混合方法设计，综合分析定性照顾者访谈 （n = 25） 和两年前瞻性纵向队列调查数据 （n = 215， 1018 次观察）。结果： 定性访谈的结果显示，护理人员对使用饲管的老年人降低 QoL 的期望以及他们自己与做出喂养决定相关的痛苦和促使计划管饲计划的恐惧。在为期两年的研究期间，16% 的社区老年人患有晚期痴呆症依赖饲管。调整潜在的混杂因素并使用工具变量估计，管饲与老年人 QoL 降低 （P < .05） 和照顾者焦虑和抑郁增加 （P < .10） 相关。结论 与专家指南一致，我们发现管饲与痴呆老年人的生活质量显著降低相关，相对于没有饲管的老年人，护理人员的痛苦增加。尽管护理人员认识到老年人使用饲管会降低 QOL，但许多人表达了与喂养选择相关的焦虑。我们的研究结果表明，需要决策工具来支持护理人员做出符合其价值观的明智决定。