Natural history of feeding-tube use in nursing home residents with advanced dementia.
OBJECTIVE
Despite the evidence that feeding-tube use in persons with advanced dementia is not associated with improved outcomes, there remains striking variation in their use. Yet, little is known about the national incidence of feeding-tube insertions, the circumstances of their insertion, and post-insertion health care use.


METHODS
Secondary analysis of Minimum Data Set merged onto Medicare Claims Files.


METHODS
Nursing home residents (NHR) without a feeding tube.


METHODS
NHR were followed for up to 1 year to see whether a feeding tube was inserted and then followed for 1 year after insertion to examine health care use and survival.


RESULTS
The incidence of feeding-tube insertion was 53.6/1000 residents. Most (68.1%) feeding-tube insertions were performed in an acute care hospital with the most common reasons for admission being pneumonia, dehydration, and dysphagia. One year post-insertion mortality was 64.1% with median survival of 56 days. Within 1 year, 19.3% of those who had a feeding tube inserted required a tube replacement or repositioning within a median 145 days after the initial insertion. Over 1 year, tube feeding was associated with an average of 9.1 hospitalized days per person, 1.0 hospitalizations, 0.3 emergency room visits that did not result in a hospital admission.


CONCLUSIONS
Most feeding tubes are inserted in an acute care hospital. Feeding-tube insertions are also associated with poor survival and significant rate of health care use after insertion.
The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA.
Sylvia
S
Kuo
Ramona L
RL
Rhodes
Susan L
SL
Mitchell
Vincent
V
Mor
Joan M
JM
Teno
D000203:Activities of Daily Living; D016223:Advance Directives / Q000706:statistics & numerical data; D017677:Age Distribution; D000368:Aged; D003704:Dementia / Q000453:epidemiology*; D006233:Persons with Disabilities; D005260:Female; D005500:Follow-Up Studies; D006707:Homes for the Aged; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007441:Intubation, Gastrointestinal; D008017:Life Expectancy; D008297:Male; D009735:Nursing Homes; D003668:Pressure Ulcer / Q000453:epidemiology; D011446:Prospective Studies; D044469:Racial Groups / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology