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Medline ® Abstract for Reference 55

of 'Palliative care of patients with advanced dementia'

Feeding tubes and the prevention or healing of pressure ulcers.
Teno JM, Gozalo P, Mitchell SL, Kuo S, Fulton AT, Mor V
Arch Intern Med. 2012;172(9):697.
BACKGROUND: The evidence regarding the use of feeding tubes in persons with advanced dementia to prevent or heal pressure ulcers is conflicting. Using national data, we set out to determine whether percutaneous endoscopic gastrostomy (PEG) tubes prevent or help heal pressure ulcers in nursing home (NH) residents with advanced cognitive impairment (ACI).
METHODS: A propensity-matched cohort study of NH residents with ACI and recent need for assistance in eating was conducted by matching each NH resident who had a feeding tube inserted during a hospitalization to 3 without a PEG tube inserted. Using the Minimum Data Set (MDS), we examined 2 outcomes: first, whether residents without a pressure ulcer developed a stage 2 or higher pressure ulcer (n = 1124 with PEG insertion); and second, whether NH residents with a pressure ulcer (n = 461) experienced improvement of the pressure ulcer by their first posthospitalization MDS assessment (mean [SD]time between evaluations, 24.6 [32.7]days).
RESULTS: Matched residents with and without a PEG insertion showed comparable sociodemographic characteristic,rates of feeding tube risk factors, and mortality. Adjusted for risk factors, hospitalized NH residents receiving a PEG tube were 2.27 times more likely to develop a new pressure ulcer (95% CI, 1.95-2.65). Conversely, those with a pressure ulcer were less likely to have the ulcer heal when they had a PEG tube inserted (OR 0.70 [95% CI, 0.55-0.89]).
CONCLUSIONS: Feeding tubes are not associated with prevention or improved healing of a pressure ulcer. Rather, our findings suggest that the use of PEG tube is associated with increased risk of pressure ulcers among NH residents with ACI.
Center for Gerontology and Health Care Research, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA. Joan_Teno@brown.edu