Study Examines Use of Feeding Tubes for Patients with Advanced Dementia

The Feb. 10, 2010, issue of JAMA (the Journal of the American Medical Association) includes a study by researchers from Brown University and Harvard Medical School that examines the use of feeding tubes in hospitalized nursing home patients with advanced dementia. The study's authors observe that "hospitals with certain characteristics, such as those that are larger or for-profit, are more likely to have a higher rate of feeding tube placement." The researches note that feeding tube use varies widely.

Hospitals with a culture of aggressive care at the end of life were nearly three times more likely to insert a feeding tube, according to the study. Larger or for-profit hospitals tended to use them more. Smaller, rural hospitals not affiliated with medical schools used them far less frequently.

Second author Dr. Susan Mitchell, associate professor of medicine at Harvard Medical school, said the data points to a clear need to examine how treatment decisions are made for patients with advanced dementia.

"Our results call for acute-care hospitals to examine how decisions are made for nursing home residents with advanced dementia, to ensure the decisions reflect patient wishes and values," Mitchell said.

Still, Teno said, there should always be exceptions, particularly if the use of feeding tubes reflects a patient's religious wishes.

"If a patient has strong religious wishes that they receive every bit of life-sustaining treatment regardless of outcome, we are still a society where we have to honor those wishes," Teno said. "But we need to make sure these decisions are based on patients' wishes and values."

Dr. Eric Widera at the GeriPal blog, Joanne Kenen at the New Health Dialog blog, and Drew Rosielle at Pallimed have also posted about this study.