title: Nursing home characteristics associated with tube feeding in advanced cognitive impairment.
abstract: OBJECTIVE
  To identify nursing homes factors associated with the use of tube feeding in advanced cognitive impairment.
  
  
  METHODS
  Descriptive study.
  
  
  METHODS
  The On-line Survey Certification of Automated Records (OSCAR) was used to obtain facility characteristics from 1,057 licensed nursing homes in six states from 1995 to 1996.
  
  
  METHODS
  Residents aged 65 and older with advanced cognitive impairment who had a feeding tube placed over a 1-year period were identified using the Minimum Data Set.
  
  
  METHODS
  Nursing home characteristics independently associated with feeding tube placement were determined.
  
  
  RESULTS
  Having a full-time speech therapist on staff, more licensed nurses and fewer nursing assistants were independently associated with greater use of tube feeding in severely cognitively impaired residents. Other features associated with tube feeding included larger facility size, higher proportion of Medicaid beds, absence of an Alzheimer's disease unit, pressure ulcers in 10% or more of residents, and a higher proportion of residents lacking advance directives and with total functional dependency.
  
  
  CONCLUSIONS
  Assessment by a speech therapist, staffing ratios, advance directives, fiscal considerations, and specialized dementia units are potentially modifiable factors in nursing homes that may influence the practice of tube feeding in advanced cognitive impairment.
authors.affiliation: Hebrew Rehabilitation Center for Aged Research and Training Institute, Harvard Medical School, Boston, Massachusetts 02131, USA. smitchell@mail.hrca.harvard.edu
authors.forename: Susan L
authors.initials: SL
authors.lastname: Mitchell
authors.forename: Dan K
authors.initials: DK
authors.lastname: Kiely
authors.forename: Muriel R
authors.initials: MR
authors.lastname: Gillick
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000628:therapy*; D004750:Enteral Nutrition / Q000706:statistics & numerical data*; D006801:Humans; D008484:Medicaid; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000592:standards* / Q000706:statistics & numerical data; D003668:Pressure Ulcer / Q000453:epidemiology; D014481:United States; D000078329:Workforce