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Medline ® Abstract for Reference 44

of 'Palliative care: Nursing home'

Nursing home characteristics associated with tube feeding in advanced cognitive impairment.
Mitchell SL, Kiely DK, Gillick MR
J Am Geriatr Soc. 2003;51(1):75.
OBJECTIVES: To identify nursing homes factors associated with the use of tube feeding in advanced cognitive impairment.
DESIGN: Descriptive study.
SETTING: The On-line Survey Certification of Automated Records (OSCAR) was used to obtain facility characteristics from 1,057 licensed nursing homes in six states from 1995 to 1996.
PARTICIPANTS: Residents aged 65 and older with advanced cognitive impairment who had a feeding tube placed over a 1-year period were identified using the Minimum Data Set.
MEASUREMENTS: Nursing home characteristics independently associated with feeding tube placement were determined.
RESULTS: Having a full-time speech therapist on staff, more licensed nurses and fewer nursing assistants were independently associated with greater use of tube feeding in severely cognitively impaired residents. Other features associated with tube feeding included larger facility size, higher proportion of Medicaid beds, absence of an Alzheimer's disease unit, pressure ulcers in 10% or more of residents, and a higher proportion of residents lacking advance directives and with total functional dependency.
CONCLUSIONS: Assessment by a speech therapist, staffing ratios, advance directives, fiscal considerations, and specialized dementia units are potentially modifiable factors in nursing homes that may influence the practice of tube feeding in advanced cognitive impairment.
Hebrew Rehabilitation Center for Aged Research and Training Institute, Harvard Medical School, Boston, Massachusetts 02131, USA. smitchell@mail.hrca.harvard.edu