Jennifer Hanners Gutierrez

Texas Tech University Health Sciences Center School of Medicine, USA

Title: Pneumonia, depression, and mortality may increase based on feeding route in persons with dysphagia

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Biography

Jennifer Hanners Gutierrez completed her Ph.D. at the Texas Tech University Health Sciences Center (TTUHSC) in 2019. She is currently a medical speech-language pathologist at University Medical Center in Lubbock, Texas and serves as a Clinical Assistant Professor for the TTUHSC School of Medicine. In 2016, she was the keynote speaker for the Nutrition in Palliative Care Symposium (China, Hong Kong). She taught on oral feeding amid critical illness and dysphagia in Lucknow, India (2018-2020). She led international training on least risk oral feeding amid life-limiting illness (2019) and conducts associated research, publishing seminal work in 2024.

Abstract

Overmedicalization of patients with age and amid critical or life-limiting illness is a concern. Patients with serious health care complications may have dysphagia (difficulty swallowing), and as a result, a feeding tube is often recommended for nutrition. Past studies have reported harm from use of tube feeding with certain patient populations, such as persons diagnosed with advanced dementia, end-stage stroke, or end-stage Chronic Obstructive Pulmonary Disease (COPD). Our aim was to investigate patient outcomes (pneumonia, depression, mortality) by feeding route (oral or tube) in persons diagnosed with end-stage stroke or COPD and dysphagia. Archival data analysis revealed pneumonia was 10.14 times more likely to occur in participants who were tube fed (OR = 10.14; p < .001). Depression (OR = 2.79; p = .01) and mortality (OR = 3.02; p < .01) were also more likely with tube feeding versus oral feeding. I then collaborated with a renowned Palliative Medicine physician with an aim to complete a prospective study (now pending publication) which mimicked the original study’s design across additional diagnoses and replicated results. Based on the results of my research endeavors related to the best option for feeding route when a patient desires nutrition amid life-limiting illness with dysphagia, I have worked diligently to collect data at my hospital over the past 2 years. My team has discovered effective risk reduction strategies. If a patient elects to eat by mouth with risk of aspiration by informed autonomous consent, oral feeding can still be accomplished with dignity and comfort. Research and clinical findings should encourage consideration of oral feeding at the end of life and, with age, a patient’s continued desire to enjoy favorite foods and drinks should be heavily weighed. The choice to eat orally should not be withdrawn by default, as evidence does not support this practice.