Tube Feeding in Nursing Home Residents with Severe and Irreversible Cognitive Impairment

Gessert, Charles E.; Mosier, Michael; Brown, Edward F.; Frey, Bruce B.

doi:10.1111/j.1532-5415.2000.tb03869.x

Cited by 72 publications

(76 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Part III presented preference, physician personal, patient, and situational factors (associated with tube feeding in prior literature) [17][18][19][20] and asked the physician to rate the importance of each factor in their decision to withhold or withdraw tube feeding on a three-point Likert scale.…”

Section: Measurementmentioning

confidence: 99%

“…10,14,15 Physician ethnicity was associated with tube feeding decisions, 16 and patient and institutional factors associated with tube feeding in nursing home patients have been identified in previous observational studies. [17][18][19][20] However, the physicians' perception of the importance of these factors in tube-feeding decision-making has not been examined.…”

Section: Introductionmentioning

confidence: 99%

“…21,22 These rates contrast with the inverse relationship between tube feeding and advance directive completion in nursing home patients seen nationally. 17,20,22 The cosmopolitan population of patients in Hawaii differs from the rest of the United States, and comprises 24% white; 23% Hawaiian, part Hawaiian, or other Pacific Islander; 17% Japanese; 14% Filipino; 5% Chinese, with additional groups (African American, Hispanic, Korean, other Asian, and others) comprising less than 2% each. 23 Hawaii's physicians are also very ethnically diverse.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Factors Associated with Physician Decision-Making in Starting Tube Feeding

Bell

Somogyi-Zalud

Masaki

et al. 2008

Journal of Palliative Medicine

View full text Add to dashboard Cite

Background:Because tube-feeding decisions are sometimes difficult, we examined physician, institutional, and patient factors associated with these decisions.Methods: Primary care physicians (n ‫؍‬ 388) likely to manage nursing home patients in Hawaii were surveyed. Respondents indicated the factors of great importance in tube feeding decisions based on a vignette of a poststroke patient failing to thrive and family disagreement with advance directives. 2 and multiple logistic regression analyses were used to examine associations between physician demographics and factors of importance to physicians and their decisions based on the vignette. Conclusions: The decision to start or withhold tube feeding is associated with the individual physician's perception of the importance of patient wishes versus family wishes and liability concerns. Physician awareness of the influence of these factors on medical decisions may improve the decision-making process.

show abstract

Section: Measurementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Factors Associated with Physician Decision-Making in Starting Tube Feeding

Bell

Somogyi-Zalud

Masaki

et al. 2008

Journal of Palliative Medicine

View full text Add to dashboard Cite

show abstract

“…Aronheim et al (2001) found wide regional variation in the US in the use of tube feeding in residents with severe cognitive impairments, with a rate of 7.5% in the state of Maine and 40.1% in Mississippi. Within the state of Kansas, Gessert et al (2000) found that certain characteristics in the population (n = 4997) were more likely to predict tube use; odds ratios (ORs) showed that swallowing problems (OR 5.4), urban location (OR 2.9), non-white race (OR 2.7), stroke (OR 2.5) and absence of dementia (OR 2.5) were predictive of tube use. Of those dependent in all activities of daily living, 74% used tubes and 80.1% of those with either chewing or swallowing problems had tubes.…”

Section: Use Of Tube Feedingmentioning

confidence: 98%

Tube feeding: Prolonging life or death in vulnerable populations?

Amella¹,

Lawrence²,

Gresle³

2005

Mortality

View full text Add to dashboard Cite

Tube feeding can be an appropriate and effective means of providing nutrition for individuals who are unable to achieve adequate nourishment orally because of various medical problems. However, the delivery of nutrients by tube feeding can cause ethical dilemmas in cases where the effectiveness of tube feeding diminishes and medical complications increase. The decision to tube feed is often influenced by regional and cultural preferences, as well as the high cost of providing mealtime assistance. The effectiveness and appropriateness of tube feeding has been the subject of much debate as it applies to those with severe cognitive impairments and those who are in a persistent vegetative state (PVS). Recent research shows that in these vulnerable populations, tube feeding alone does not necessarily prevent malnutrition and risk of infection or improve functional status and comfort. While advanced directives allow an individual to make decisions about his or her care at the end of life, court cases and religious doctrine examine the individual's right to autonomous decision making in opposition to preserving the sanctity of life. As long as the outcome of this debate is largely undecided, the process of dying may be prolonged for those who can no longer advocate for themselves.

show abstract

“…For example, non-White residents are significantly more likely to be tube fed than White NH residents (Mitchell, Teno, & Roy, 2003). NHs with full-time speech therapists on staff, fewer nursing assistants, and located in an urban setting are associated with higher rates (Gessert, Mosier, Brown, & Frey, 2000). Research also suggests financial incentives exist for gastroenterologists, hospitals, and NHs .…”

mentioning

confidence: 99%