Rural‐Urban Differences in End‐of‐life Care: The Use of Feeding Tubes

Abstract

Efforts to improve end-of-life care have increased during the past decade. The goals of these efforts include increasing patient autonomy and reducing or more selectively using intensive medical interventions near the end of life. In this light, examination of community-to-community variations in end-of-life practices may serve to clarify the values and goals of different populations, as well as the roles of patients, families and professionals in bringing about specific patterns of medical care. This study examined the use of feeding tubes among Kansas nursing home residents between Jan. 1, 1994, and June 30, 1998 (n = 78,895), using the Minimum Data Set. Residents with very severe, persistent and irreversible cognitive impairment (n = 4,847) were included in the study population. The location of nursing homes in urban, midsize and rural counties was an independent variable. Feeding tubes were used in 19.3 percent of the urban nursing home residents, 8.0 percent of the residents in midsize counties and 6.4 percent of the rural residents. The rate of feeding tube use was significantly higher in urban counties for most subpopulations, including men, women, whites, nonwhites, and those eligible and ineligible for Medicaid. The observed rural-urban differences in feeding tube use near the end of life may be associated with differences in access to surgical or nursing services, differences in the relationships between providers and consumers of care in different communities or differences in rural and urban cultures. Qualitative research may be useful in clarifying the roles of each of these factors.

Prevalence of Percutaneous Endoscopic Gastrostomy in Nursing Home Residents – A Nationwide Survey in Germany

“…One study comparing the tube feeding prevalence in different counties of Kansas in the United States showed considerable differences in the prevalence of tube feeding in urban (19.3%), midsized (8.0%) and rural (6.4%) counties [21] . Furthermore, use of feeding tubes in US nursing homes is not only associated with the clinical characteristics of the residents, but also depends on the fiscal, organizational and demographic features of the nursing homes [18,19] .…”

“…The corresponding use of PEG tubes may be even lower than this reported rate. Data regarding feeding tube use in US nursing homes suggest that its prevalence is not only associated with the clinical characteristics of residents, but is also independently associated with the fiscal, organizational and demographic features of the nursing home [18][19][20][21] . The prevalence of PEG tubes in German nursing homes is unknown, and the effect of institutional level factors on its use is unclear.…”

Nutritional status and delirium in long-term care elderly individuals

“…Some have linked poor nutrition to mortality (Hirdes, Frijters, & Teare, 2003;Volpato et al, 2004) or focused on tube feedings and end stage dementia in nursing home patients (Gessert & Calkins, 2001;Mitchell, Kiely, & Gillick, 2003;Murray, 2000;Okada et al, 2001;Sheiman & Pomerantz, 1998;Silver, Wellman, Arnold, Livingstone, & Byers, 2004). The following hypotheses are proposed:…”

Discrepancies among patients, family members, and physicians in Korea in terms of values regarding the withholding of treatment from patients with terminal malignancies

“…In such studies, ethnicity strongly affects the final endof-life decision. [12][13][14][15][16][17][18][19][20][21][22] In addition, in Korea and in other Asian nations, for most patients with malignant disease, family members do not want the patient to be informed of the exact status of his or her disease and sometimes do not even want the patient be informed that malignant disease has been diagnosed. The result is that patient autonomy cannot be procured at the time at which end-of-life decisions are made, and thus physicians usually discuss such decisions only with family members, who cannot always speak for the patient's exact treatment preferences.…”