Use of Feeding Tubes in Adults With Dementia Varies Widely

Review assesses tube insertion in hospitalized nursing-home residents with cognitive impairment
By Eric Metcalf
HealthDay Reporter

TUESDAY, Feb. 9 (HealthDay News) -- Feeding tube insertions in older individuals with advanced cognitive impairment -- a practice that has drawn scrutiny in the literature -- varied widely in U.S. hospitals during a recent period, according to research published in the Feb. 10 issue of the Journal of the American Medical Association.

Joan M. Teno, M.D., of Brown University in Providence, R.I., and colleagues analyzed Medicare claims data on residents of nursing homes with advanced cognitive impairment who were admitted to acute care hospitals between 2000 and 2007. Subjects were at least 66 years of age, and the hospitals in the study admitted at least 30 such patients during this period.

The researchers found that the rate of feeding tube insertion ranged from zero to 38.9 per 100 hospitalizations. The average per 100 admissions decreased from 7.9 in 2000 to 6.2 in 2007. Factors associated with higher insertion rates included for-profit ownership compared to government ownership; more than 310 beds compared to 100 or fewer; and more intensive care unit use in the last six months of life.

"Studies have suggested that more than one-third of nursing home residents with advanced cognitive impairment have feeding tubes inserted and the majority of these tubes are placed during acute care hospitalizations," the authors conclude. "Future research is needed to better understand why this [national] variation occurs and to intervene to ensure that feeding tube insertion reflects informed patient preferences based on discussion of the evidence of risks versus benefits."

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