Use of Feeding Tubes in Nursing Home Residents With Severe Cognitive Impairment

Teno, Joan M.

doi:10.1001/jama.287.24.3206

Cited by 47 publications

(27 citation statements)

References 12 publications

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“…Previous studies have demonstrated striking variation in the prevalence of feeding tubes with national estimates of 18 to 34%;16;18;19;22 only one study examined incidence of feeding tubes and found a two-year incidence rate of 9.7% in the state of Washington 12. Merging the national MDS data repository with Medicare claims, we were able to examine the incidence of feeding tube use among persons with advanced cognitive impairment defined as CPS of 4, 5, and 6.…”

Section: Discussionmentioning

confidence: 99%

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Natural History of Feeding-Tube Use in Nursing Home Residents With Advanced Dementia

Kuo

Rhodes

Mitchell

et al. 2009

Journal of the American Medical Directors Association

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143

120

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Objectives-Despite the evidence that feeding tube use in persons with advanced dementia is not associated improved outcomes, there remains striking area variation in their use. Yet, little is known about the national incidence of feeding tube insertions, the circumstances of their insertion, and postinsertion health care utilization. Design-Secondary analysis of Minimum Data Set merged onto Medicare Claims FilesSetting and Participants-Nursing home residents (NHR) without a feeding tube Measurements-NHR were followed for up to one year to see whether a feeding tube was inserted and then followed for one year post insertion to examine health care utilization and survival.

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Section: Discussionmentioning

confidence: 99%

“…Studies have shown rates from 18 to 34% nationally,16-19 with substantial state variation ranging from 7.5 to 40% 18. There remain important gaps in our understanding of the use of this procedure in persons with advanced dementia.…”

Section: Introduction*mentioning

confidence: 99%

Natural History of Feeding-Tube Use in Nursing Home Residents With Advanced Dementia

Kuo

Rhodes

Mitchell

et al. 2009

Journal of the American Medical Directors Association

Self Cite

143

120

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“…To control for regional influences, both facilities were located in the same health referral region in South Carolina, a state with relatively high rates of feeding-tube use 9. To select facilities, minimum data set (MDS) information was used to determine tube-feeding rates among residents with advanced cognitive impairment in all NHs in the state (n=179) on a randomly selected date in 2001 (the most recent data available at the time of study initiation).…”

Section: Methodsmentioning

confidence: 99%

The Influence of Nursing Home Culture on the Use of Feeding Tubes

et al. 2010

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Background Nationwide, many nursing home (NH) residents with advanced cognitive impairment are tube fed, despite no demonstrable benefits of this intervention in this population. Studies suggest that organizational features of NHs are associated with this practice, but underlying reasons for these associations are poorly understood. Methods We conducted a focused ethnographic study of 2 NHs in South Carolina, 1 with a high tube-feeding rate (41.8%) in patients with advanced dementia, and 1 with a low rate (10.7%). Data were collected about physical environment, mealtime and decision-making processes, and explicit and implicit values using 80 hours of direct observation, semistructured interviews with 30 key facility personnel, and abstraction of publicly available material describing the facilities. Data were analyzed using qualitative methods. Results Striking variations in organizational culture were identified. The low-use NH had a homelike environment centered on food as an important component of daily life, mealtimes staffed with knowledgeable nursing assistants who valued hand feeding, and advance care planning that included family and palliative care options. In contrast, the high-use NH had an institution like environment, poorly staffed mealtimes, and staff attitudes favoring feeding tubes to avoid aspiration and to meet perceived regulatory compliance. Conclusions The NH culture influences the approach to feeding in advanced cognitive impairment, whether by hand or placement of a feeding tube. Key features of NHs with a low rate of tube-feeding use include a physical environment that promotes the enjoyment of food, administrative support, and empowerment of staff to value hand feeding and shared decision-making processes involving family members.

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“…4 Aggressive approaches may include the use of resuscitation measures (including chest compression and intubation), active medical treatment, wide use of antibiotics, and feeding tubes. [5][6][7][8] A different approach involves hospicetype palliative care. 1,9,10 Guidelines and key criteria for enrolling dementia patients in hospice have been proposed that limit eligibility only to those patients who are at Functional Assessment Stage (FAST) 7 (i.e., virtually mute and bedridden).…”

Section: Introductionmentioning

confidence: 99%

Dying dementia patients: Too much suffering, too little palliation

Aminoff

Adunsky

2005

Am J Hosp Palliat Care

108

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Patient suffering is a pathological syndrome traditionally viewed as encompassing psychological distress, spiritual concerns, and various aspects of physical pain. There is insufficient clinical evidence for suffering in dying dementia patients, which may lead to inappropriate evaluation and insufficient palliative treatment. Our objective was to evaluate the suffering of terminal dementia patients over time, from admission to a geriatric ward to the last day of life. The study included consecutive end-stage dementia patients in a general geriatric department of a tertiary hospital. Patients were evaluated weekly by the Mini Suffering State Examination scale (MSSE) which measures many domains related to suffering. Seventy-one patients were studied. Mean survival of patients was 38.0 +/- 5.1 days. MSSE increased during hospital stay from 5.62 +/- 2.31 to 6.89 +/- 1.95 (p < 0.001). According to MSSE scale, 63.4 percent and 29.6 percent of patients died with a high and intermediate level of suffering, respectively. Only 7 percent of the patients died with a low level of suffering. In particular, patients were restless (p < 0. 001), had pressure sores (p = 0.01), and were considered medically unstable (p < 0.001). We concluded that, despite traditional medical and nursing care, a large proportion of dying dementia patients experience an increasing amount of suffering as they approach death. New palliative treatment approaches should be developed for these patients.

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Use of Feeding Tubes in Nursing Home Residents With Severe Cognitive Impairment

Cited by 47 publications

References 12 publications

Natural History of Feeding-Tube Use in Nursing Home Residents With Advanced Dementia

Natural History of Feeding-Tube Use in Nursing Home Residents With Advanced Dementia

The Influence of Nursing Home Culture on the Use of Feeding Tubes

Dying dementia patients: Too much suffering, too little palliation

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