Survival Estimates for Patients with Abnormal Swallowing Studies

Abstract

Mortality is high in patients with severely abnormal swallowing studies. Common clinical variables can be used to identify groups of patients with particularly poor prognoses. This information may help guide discussions regarding possible PEG placement.

A Cross‐National Survey of Tube‐Feeding Decisions in Cognitively Impaired Older Persons

“…There were several significant differences in the area of communication between the two sites. Compared with SDMs in Ottawa, SDMs in Boston were: (1) were more likely to have discussed the decision with an MD (89.6% vs 73.9%, P = .05), (2) more likely to have spoken to the primary care physician about the decision (rather than the consultant who put in the tube) (81.3% vs 45.6%, P < .001), and (3) more likely to feel that they made the decision to tube‐feed rather than seeing it as a unilateral decision made by a physician (72.9% vs 32.6%, P < .001). Consistent at both sites, the SDM expressed that they understood the benefits (83.0%) of tube‐feeding better than the risks (48.9%).…”

“…Once the tube‐fed patients were identified, a chart review was conducted to determine their eligibility for the study. Eligibility criteria included: (1) aged more than 65 years when the tube was placed; (2) tube‐feeding for at least 2 months; (3) inability to make medical decisions at the time of tube placement; and (4) the name and location of the substitute decision‐maker could be determined. Decision‐making capability was determined by review of the medical record and, if necessary, by direct discussion with the nurse or physician involved in the patient's care.…”

“…Unfortunately, there is little information available regarding the risks and benefits of tube‐feeding to help guide this decision. Data to support the purported medical benefits of tube‐feeding, such as improved survival, 1–3 or the prevention of aspiration, 4–13 are lacking. Furthermore, advance directives regarding wishes for tube‐feeding are often not available.…”

“…Under these circumstances, tube‐feeding decisions are more likely to occur in a nursing home rather than in an acute hospital. Therefore, the objectives of this study are: (1) to validate anecdotal observations regarding cross‐national differences of long‐term tube‐feeding practices in US and Canadian settings; (2) to determine how these cross‐national differences impact the tube‐feeding decision‐making; and (3) to determine if the deficiencies found in the decision‐making process in Ottawa were generalizable to other settings.…”

Omission of Dysphagia Therapies in Hospital Discharge Communications

“…Moreover, hip fracture patients discharged to sub-acute care have high-rates of co-existing dementia [10-12], which places them at significantly increased dysphagia risk [13-16]. Dysphagia leads to a myriad of complications, including malnutrition, dehydration, and pneumonia, costing more than $4.4 billion annually [17, 18]. It is often diagnosed within the hospital setting by speech-language pathologists (SLP), who assess swallowing ability and make effective dietary, behavioral, and provider recommendations to decrease the risk of dysphagia-related complications [19-25].…”