title: A cross-national comparison of institutionalized tube-fed older persons: the influence of contrasting healthcare systems.
abstract: OBJECTIVE
  Different health care settings may influence the type of patients selected for long-term tube-feeding. Clinical characteristics of older, tube-fed institutionalized subjects living in Ontario, Canada were compared with those in the United States (US).
  
  
  METHODS
  A cross-sectional cohort study Setting: Nursing homes in the states of Mississippi, Texas, and Vermont (US) and chronic care facilities in Ontario.
  
  
  METHODS
  Tube-fed residents older than age 65 living in facilities in the US between January 1, 1996, and March 31, 1997 (n = 859), and in institutions in Ontario between January 1, 1996, and December 31, 1997 (n = 913).
  
  
  METHODS
  Data were obtained from Minimum Dataset assessments at both sites. Demographic and clinical characteristics were compared between tube-fed subjects living in the US and those in Canadian facilities.
  
  
  RESULTS
  In a logistic regression model, the following characteristics were significantly more likely to be found among tube-fed subjects in the US than in those in Ontario: greater impairment of cognitive performance, cardiopulmonary disease, a diagnosis of dementia, female, and age greater than 80 years. Characteristics that were significantly less likely to be present among the US tube-fed subjects included: recurrent lung aspirations, a chewing or swallowing problem, do not resuscitate status, restraint use, weight loss, and stroke.
  
  
  CONCLUSIONS
  Clinical characteristics differ between older, institutionalized tube-fed subjects in Ontario and in US nursing homes. In order to put these differences into context, consideration must be given to how the contrasting healthcare systems in these two countries may drive decision-making for long-term tube-feeding.
authors.affiliation: The Division of Geriatrics and Loeb Health Research Institute, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario.
authors.forename: S L
authors.initials: SL
authors.lastname: Mitchell
authors.forename: D K
authors.initials: DK
authors.lastname: Kiely