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The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment.
Arch Intern Med. 1997 Feb 10; 157(3):327-32.AI

Abstract

BACKGROUND

The provision of artificial enteral nutrition to an aged person with severe cognitive impairment is a complex dilemma in the long-term care setting.

OBJECTIVE

To determine the risk factors and impact on survival of feeding tubes in nursing home residents with advanced cognitive impairment.

METHODS

We conducted a cohort study with 24-month follow-up using Minimum Data Set resident assessments on 1386 nursing home residents older than 65 years with recent progression to severe cognitive impairment in the state of Washington. Residents within this population who underwent feeding tube placement were identified. Clinical characteristics and survival for a period of 24 months were compared for residents who were and were not tube fed.

RESULTS

Among the residents with recent progression to severe cognitive impairment, 9.7% underwent placement of a feeding tube. Factors independently associated with feeding tube placement included age younger than 87 years (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.25-2.78), aspiration (OR, 5.46; 95% CI, 2.66-11.20), swallowing problems (OR, 3.00; 95% CI, 1.81-4.97), pressure ulcer (OR, 1.64; 95% CI, 1.23-2.95), stroke (OR, 2.12; 95% CI, 1.17-2.62), less baseline functional impairment (OR, 2.07; 95% CI, 1.27-3.36), no do-not-resuscitate order (OR, 3.03; 95% CI, 1.92-4.85), and no dementia (OR, 2.17; 95% CI, 1.43-3.22). Survival did not differ between groups of residents with and without feeding tubes even after adjusting for independent risk factors for feeding tube placement.

CONCLUSIONS

There are specific risk factors associated with feeding tube placement in nursing home residents with severe cognitive impairment. However, there is no survival benefit compared with similar residents who are not tube fed. These prognostic data are important for health care providers, families, and patients making decisions regarding enteral nutritional support in long-term care.

Authors+Show Affiliations

Hebrew Rehabilitation Center for Aged Research and Training Institute, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass. USA. mitchell@mail.hrca.harvard.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

9040301

Citation

Mitchell, S L., et al. "The Risk Factors and Impact On Survival of Feeding Tube Placement in Nursing Home Residents With Severe Cognitive Impairment." Archives of Internal Medicine, vol. 157, no. 3, 1997, pp. 327-32.
Mitchell SL, Kiely DK, Lipsitz LA. The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment. Arch Intern Med. 1997;157(3):327-32.
Mitchell, S. L., Kiely, D. K., & Lipsitz, L. A. (1997). The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment. Archives of Internal Medicine, 157(3), 327-32.
Mitchell SL, Kiely DK, Lipsitz LA. The Risk Factors and Impact On Survival of Feeding Tube Placement in Nursing Home Residents With Severe Cognitive Impairment. Arch Intern Med. 1997 Feb 10;157(3):327-32. PubMed PMID: 9040301.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment. AU - Mitchell,S L, AU - Kiely,D K, AU - Lipsitz,L A, PY - 1997/2/10/pubmed PY - 1997/2/10/medline PY - 1997/2/10/entrez KW - Empirical Approach KW - Mental Health Therapies KW - Professional Patient Relationship SP - 327 EP - 32 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 157 IS - 3 N2 - BACKGROUND: The provision of artificial enteral nutrition to an aged person with severe cognitive impairment is a complex dilemma in the long-term care setting. OBJECTIVE: To determine the risk factors and impact on survival of feeding tubes in nursing home residents with advanced cognitive impairment. METHODS: We conducted a cohort study with 24-month follow-up using Minimum Data Set resident assessments on 1386 nursing home residents older than 65 years with recent progression to severe cognitive impairment in the state of Washington. Residents within this population who underwent feeding tube placement were identified. Clinical characteristics and survival for a period of 24 months were compared for residents who were and were not tube fed. RESULTS: Among the residents with recent progression to severe cognitive impairment, 9.7% underwent placement of a feeding tube. Factors independently associated with feeding tube placement included age younger than 87 years (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.25-2.78), aspiration (OR, 5.46; 95% CI, 2.66-11.20), swallowing problems (OR, 3.00; 95% CI, 1.81-4.97), pressure ulcer (OR, 1.64; 95% CI, 1.23-2.95), stroke (OR, 2.12; 95% CI, 1.17-2.62), less baseline functional impairment (OR, 2.07; 95% CI, 1.27-3.36), no do-not-resuscitate order (OR, 3.03; 95% CI, 1.92-4.85), and no dementia (OR, 2.17; 95% CI, 1.43-3.22). Survival did not differ between groups of residents with and without feeding tubes even after adjusting for independent risk factors for feeding tube placement. CONCLUSIONS: There are specific risk factors associated with feeding tube placement in nursing home residents with severe cognitive impairment. However, there is no survival benefit compared with similar residents who are not tube fed. These prognostic data are important for health care providers, families, and patients making decisions regarding enteral nutritional support in long-term care. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/9040301/The_risk_factors_and_impact_on_survival_of_feeding_tube_placement_in_nursing_home_residents_with_severe_cognitive_impairment_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/157/pg/327 DB - PRIME DP - Unbound Medicine ER -