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 18 November 2017

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News

Factors associated with feeding tube use in patients with cognitive impairment

More than one third of severely cognitively impaired residents in United States nursing homes have feeding tubes, finds a research team in this week's issue of the Journal of the American Medical Association.

News image

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It has previously been found that the use of feeding tubes is not beneficial for older persons with advanced dementia.

However, research has shown that there is a 10-fold variation in this practice across the United States.

In this study, researchers aimed to identify facility and resident characteristics associated with feeding tube use in US nursing homes residents with severe cognitive impairment.

34% of residents with advanced cognitive impairment had feeding tubes.
Journal of the American Medical Association

The team performed a cross-sectional study of 186,835 nursing home residents with advanced cognitive impairment.

All subjects included in the study had Minimum Data Set assessments within 60 days of 1 April 1999. In addition, all subjects resided in Medicare- or Medicaid-certified US nursing homes.

The researchers evaluated facility and resident characteristics described in the 1999 On-line Survey Certification of Automated Records, and the 1999 Minimum Data Set.

They also used multivariate analysis to determine the facility and resident factors independently associated with feeding tube use.

The team found that 34% of residents with advanced cognitive impairment had feeding tubes.

Factors associated with an increased likelihood of feeding tube use included younger age, nonwhite race, male sex, divorced marital status, lack of advance directives, a recent decline in functional status, and no diagnosis of Alzheimer disease.

When the team controlled for patient factors, they were able to identify several facility characteristics which increased the likelihood of patients having a feeding tube. These included facilities that were for profit (adjusted odds ratio [OR], 1.09), located in an urban area (OR, 1.14), having more than 100 beds (OR, 1.04), and lacking a special dementia care unit (OR, 1.11).

In addition, they determined that feeding tube use was more likely among residents in facilities with a smaller proportion of do-not-resuscitate orders, a higher prevalence of nonwhite residents, and no nurse practitioner or physician assistant on staff.

Dr Susan Mitchell's team concluded that, "More than one third of severely cognitively impaired residents in US nursing homes have feeding tubes".

"Feeding tube use is independently associated with both the residents' clinical characteristics and the nursing homes' fiscal, organizational, and demographic features".

JAMA 2003; 290: 73-80
04 July 2003

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