title: Enteral feeding in end-stage dementia: a comparison of religious, ethnic, and national differences in Canada and Israel.
abstract: BACKGROUND
  Although enteral feeding in end-stage dementia is thought by many clinicians to be "futile," it is still widely used. We examined rates of tube feeding (gastrostomy or nasogastric) in end-stage dementia in hospitals in both Canada and Israel, and hypothesized that Canadian non-Jewish affiliated hospitals would have the lowest (and Israeli institutions the highest), with Canadian Jewish hospitals exhibiting intermediate rates.
  
  
  METHODS
  We conducted a cross-sectional survey of six geriatric long-term hospitals: two in Israel and four in Canada (two Jewish affiliated, two not; two in Ontario, two in Quebec province). Patients with end-stage dementia were assessed and further analyzed for type of feeding.
  
  
  RESULTS
  In the six hospitals, 2287 long-term beds were surveyed, of which 1358 (59.4%) were used by demented patients of whom 376 (27.7%) were severely demented (Global Deterioration Scale-level 7). Of these, 24.5% (92) were fed by nasogastric tube or gastrostomy tube. Significant differences in tube-feeding prevalence were found between Canada (11%) and Israel (52.9%), with only 4.7% seen in non-Jewish Canadian institutions. Jewish affiliated hospitals in Canada exhibited an intermediate rate of 19.6%. However, for within-country dyads, wide differences were also found. When we examined patient religion, we found that Canadian non-Jewish patients had the lowest rates (3.2%), Israeli Jewish patients the highest (51.7%), and Canadian Jewish patients exhibited an intermediate rate (19.0%) of tube use.
  
  
  CONCLUSIONS
  Despite reservations concerning its utility, feeding tube use is reasonably widespread in patients who have reached the stage of severe dementia. Canadian institutions exhibited a lower prevalence of feeding tube use than did Israeli hospitals. Between-country and between-province differences in practice may be explained by some combination of administrative and/or financial incentives, religion, and culture; within-country and within-ethnic group differences may be caused, at least in part, by differing institutional cultures.
authors.affiliation: Department of Geriatrics, Soroka Hospital, Ben Gurion University of the Negev, Beer-sheva, Israel. markclar@bgu.ac.il
authors.forename: A Mark
authors.initials: AM
authors.lastname: Clarfield
authors.forename: Johanne
authors.initials: J
authors.lastname: Monette
authors.forename: Howard
authors.initials: H
authors.lastname: Bergman
authors.forename: Michele
authors.initials: M
authors.lastname: Monette
authors.forename: Yehoshua
authors.initials: Y
authors.lastname: Ben-Israel
authors.forename: Yehezkel
authors.initials: Y
authors.lastname: Caine
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Charles
authors.forename: Michael
authors.initials: M
authors.lastname: Gordon
authors.forename: Brian
authors.initials: B
authors.lastname: Gore
mesh_terms: D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003704:Dementia / Q000208:ethnology* / Q000628:therapy*; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D012067:Religion; D012189:Retrospective Studies; D012720:Severity of Illness Index