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More Than One-Third of Nursing Home Residents with Severe Cognitive Impairments Have Feeding Tubes

The use of feeding tubes among nursing home residents with severe cognitive impairment is common and is associated with patient characteristics as well as nursing home-related factors, according to a study in the July 2 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, “A growing proportion of the approximately four million older U.S. adults with Alzheimer’s disease or other dementias are now surviving to the advanced stages of their illnesses. Eating and swallowing problems typically develop during the terminal stages of dementias. “The widespread use of feeding tubes among older persons with advanced cognitive impairment in the United States is concerning amid growing empirical data and expert opinion indicating that feeding tube use has no demonstrable health benefits in this population and may be associated with increased risks and discomfort,” the authors write.

Susan L. Mitchell, M.D., M.P.H., from Hebrew Rehabilitation Center for Aged’s Research and Training Institute, Boston, and colleagues examined how patient factors and facility characteristics are associated with feeding tube use among severely cognitively impaired older persons in U.S. nursing homes. The authors analyzed data from 186,835 individuals with advanced cognitive impairment who resided in Medicare- or Medicaid-certified U.S. nursing homes in 1999.

“Thirty-four percent of residents with advanced cognitive impairment had feeding tubes (n = 63,101),” the authors report. “Resident characteristics associated with a greater likelihood of feeding tube use included younger age, nonwhite race, male sex, divorced marital status, lack of advance directives, a recent decline in functional status, and no diagnosis of Alzheimer’s disease.” The authors continue, “Controlling for these patient factors, residents living in facilities that were for profit, located in an urban area, having more than 100 beds and lacking a special dementia care unit had a higher likelihood of having a feeding tube. Additionally, feeding tube use was more likely among residents living in facilities that had a smaller proportion of residents with do-not-resuscitate orders, had a higher prevalence of non-white residents, and lacked a nurse practitioner or physician assistant on staff.”

“Our findings highlight potential interventions and policy changes at the facility level that could influence this practice,” the authors write. “Comprehensive implementation of advanced care planning is likely to reduce the use of feeding tubes. Feeding tube use may also be reduced by having providers and units dedicated to the care of nursing home residents with advanced cognitive impairment,” the authors conclude.