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Medline ® Abstract for Reference 41

of 'Palliative care: Nursing home'

Does feeding tube insertion and its timing improve survival?
Teno JM, Gozalo PL, Mitchell SL, Kuo S, Rhodes RL, Bynum JP, Mor V
J Am Geriatr Soc. 2012 Oct;60(10):1918-21. Epub 2012 Sep 24.
OBJECTIVES: To examine survival with and without a percutaneous endoscopic gastrostomy (PEG) feeding tube using rigorous methods to account for selection bias and to examine whether the timing of feeding tube insertion affected survival.
DESIGN: Prospective cohort study.
SETTING: All U.S. nursing homes (NHs).
PARTICIPANTS: Thirty-six thousand four hundred ninety-two NH residents with advanced cognitive impairment from dementia and new problems eating studied between 1999 and 2007.
MEASUREMENTS: Survival after development of the need for eating assistance and feeding tube insertion.
RESULTS: Of the 36,492 NH residents (88.4% white, mean age 84.9, 87.4% with one feeding tube risk factor), 1,957 (5.4%) had a feeding tube inserted within 1 year of developing eating problems. After multivariate analysis correcting for selection bias with propensity score weights, no difference was found in survival between the two groups (adjusted hazard ratio (AHR) = 1.03, 95% confidence interval (CI) = 0.94-1.13). In residents who were tube-fed, the timing of PEG tube insertion relative to the onset of eating problems was not associated with survival after feeding tube insertion (AHR = 1.01, 95% CI = 0.86-1.20, persons with a PEG tube inserted within 1 month of developing an eating problem versus later (4 months) insertion).
CONCLUSION: Neither insertion of PEG tubes nor timing of insertion affect survival.
Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island.