A professor at the Brown University Medical School was the lead author on a recent study published in the Journal of the American Medical Association (JAMA), Hospital Characteristics Associated With Feeding Tube Placement in Nursing Home Residents With Advanced Dementia (abstract). Joan M. Teno, MD, used Medicare data from 2000 to 2007 to evaluate how often feeding tubes were inserted into late-stage dementia patients, age 66 or older, who were hospitalized by the nursing home or skilled nursing communities where they lived. The records used in the research came from data that included 163,000 patients who were hospitalized 281,000 times at 2,800 hospitals. The data for the study was taken from Medicare claims files.
The research concluded, “Among nursing home residents with advanced cognitive impairment admitted to acute care hospitals, for-profit ownership, larger hospital size, and greater ICU use was associated with increased rates of feeding tube insertion…” The results, by hospital, are posted at this web site.
The study found that people in nursing homes who could not feed themselves were often admitted to hospitals where feeding tubes were inserted, even if they had a medical directive that clearly asked not to have the procedure. At one-fourth of the hospitals, a late-state dementia patient had a 10 percent or higher chance of having a feeding tube inserted; at hospitals with the highest rates, those patients had nearly a 40 percent chance.
Those of us with parents who are moving toward late state dementia should keep three things in mind in order to protect our parents and safeguard their end-of-life wishes.
- Be sure the appropriate end-of-life documents are in all records and check periodically to be sure they have not been misplaced (in our case they were misplaced once when we needed them).
- If a parent is a resident of a nursing home, assisted living, or rehab community and is taken to the hospital, bring copies of these documents with you when you go to the hospital.
- If you live out-of-town, be sure medical directive documents go to the hospital with your parent or ask that they be delivered.
- Study: End-of-Life Care Must Reflect Patient Wishes and Values (Brown University press release)
- Brown-led Study: Use of Feeding Tubes in Hospitals Appears High (Providence Journal)
- Feeding tubes may be overused in demented patients (Reuters)
- Too Many With End-Stage Dementia Get Feeding Tubes (Business Week)