Just the other day, a few visitors were directed to our website after searching Google for this information:
feeding tube decision
removing a feeding tube
And, Dilys, one of our bloggers, posted an entry earlier this week about her mum’s hospitalization and the doctors’ suggestion that a feeding tube be inserted.
Wondering about whether to insert a feeding tube can be a nerve-wracking and gut-wrenching decision.
Yesterday, results of a recent study about the prevalence of hospitalized persons with advanced Alzheimer’s receiving feeding tubes was released. The following press release about the study provides the details:
Despite being of questionable benefit for patients with advanced dementia, new research finds that hospitals with certain characteristics, such as those that are larger or for-profit, are more likely to have a higher rate of feeding tube placement, according to a study in the February 10 issue of JAMA (Journal of American Medical Association).
Dementia is a leading cause of death in the United States, and estimates project that 16 million individuals will have dementia by 2050. Characteristics of advanced dementia can include severe functional impairment, eating problems, malnutrition and recurrent infections. “The decision to place a feeding tube in a patient with advanced dementia is one of the sentinel decisions that family members and health care professionals grapple with in the nursing home environment. Two widely cited structured literature reviews conclude that the use of feeding tubes in patients with advanced dementia does not improve survival, prevent aspiration pneumonia, heal or prevent decubitus ulcers [bed sores], or improve other clinical outcomes,” the authors write.
Despite this evidence, a previous study reported that more than one-third of nursing home residents with advanced dementia have a feeding tube inserted, and other research has indicated that many of these patients had their feeding tube inserted during an acute care hospitalization, according to background information in the article.
Joan M. Teno, M.D., M.S., of Brown University, Providence, R.I., and colleagues examined the characteristics of acute care hospitals associated with greater rates of feeding tube insertion among nursing home residents ages 66 years or older admitted with advanced cognitive impairment. Rate of feeding tube placement was based on a 20 percent sample of all Medicare Claims files and was assessed in hospitals with at least 30 such admissions between 2000 and 2007, which was 2,797 acute care hospitals for this study.
During the study period, 280,869 admissions occurred among 163,022 nursing home residents (average age, 84.0 years; 67 percent women, and 12.5 percent black residents). Between 2000 and 2007, the hospital rate of feeding tube insertion per 100 eligible admissions decreased, from a high of 7.9 in 2000 to a low of 6.2 in 2007. The rate of feeding tube insertion varied from 0 to 38.9 per 100 hospitalizations.
A higher rate of feeding tube insertions was independently associated with for-profit ownership vs. hospitals owned by state or local government, with an absolute difference of 3.0 feeding tube insertions per 100 admissions. Hospitals with a greater number of beds (more than 310 beds vs. less than 101 beds) also had higher rates of feeding tube insertion, as did those with more intensive care unit use for chronically ill patients in the last 6 months of life.
“Feeding tube insertion in persons with advanced cognitive impairment demonstrates a disconnect with the existing evidence of their effectiveness,” the authors write.
“These results are the first to our knowledge to document the national variation in rates of feeding tube insertions among acute care hospitals. Future research is needed to better understand why this variation occurs and to intervene to ensure that feeding tube insertion reflects informed patient preferences based on discussion of the evidence of risks vs. benefits.”
So…
What’s your reaction to this study? What questions or concerns do you have? Have you faced the feeding tube decision?
Resources
What If? Decisions Near Life’s End
A Physician’s Perspective: The Feeding Tube Decision
Determining the Best Care at End of Life
Related Articles
- Ahhh…. ARGH! (caregiving.com)
- Long-Term Care Costs Rise Across the Board from 2008 to 2009 (caregiving.com)
- Study: End-of-life care must reflect patient wishes and values (scienceblog.com)
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You are a disruptor. The delivery of health care starts with you, continues because of you, and ends with you. Let's disrupt together to make the world better for family caregivers. 
Shelley Webb
Having been a nurse for over 30 years (albeit mostly in the field of neonatal ICU), I have become averse to the use of feeding tubes to prolong life. One of the functions of the body, in order to prepare for death, is to shut down the ability to swallow. This is natural occurrence and should not be interrupted.
As a nurse, I also understand that doctors do things “to save lives” – it’s what they’re taught to do and they’re NOT taught to take quality of life into consideration (although that is beginning to change a little) So if they are afforded the opportunity ( vis a vis a “for profit” hospital who does not forbid the procedure), a physician will most likely opt for the feeding tube, because….it saves a life.
Fortunately, before my father’s dementia had progressed too far, he and I had talked about feeding tubes, ventilators (for artifical breathing), etc. and although he always told me he wanted to live to be 100, he had made it known that he didn’t want such life extending treatments. (He had also written this in a trust, but I did not find his trust until over a month after he died, hidden in a box with a Marilyn Monroe calendar and some Duck’s Unlimited Magazines….ah, dementia.)
If you suspect that your parent or loved is showing early signs of dementia, make sure they have a trust set up containing advance directives for health care. If it’s too late for that, make sure that there is a durable power of attorney for health care set in place.
This is also why it’s very important to set up your own trust stating your desires as to health procedures in the event of an untoward incident.
Donna W
Hey Ms. Webb, this is Ms. Webb….!
I agree with you. Mom is a DNR, and a feeding tube would be prolonging the dying process she would be in at that time. I have struggled enough with her decrease in eating since Dec. I understand her body is shutting down and neither needs or wants the amount of food she got before, so to extend this with feeding tubes, no, would not allow it, and she would not want it either.
.-= Donna W´s last blog ..On Being Savvy…. =-.
Preston Benjamin
Thank you for posting this great information with regards to the use of feeding tubes among our loved ones with dementia in many nursing home s across the country. This is a very important issue. What matters in the end is we respect the decision of one another, especially that of the patient and/or the family.