THE RISK-FACTORS AND IMPACT ON SURVIVAL OF FEEDING TUBE PLACEMENT IN NURSING-HOME RESIDENTS WITH SEVERE COGNITIVE IMPAIRMENT

Background: The provision of artificial enteral nutrition to an aged p erson with severe cognitive impairment is a complex dilemma in the lon g-term care setting. Objective: To determine the risk factors and impa ct on survival of feeding tubes in nursing home residents with advance d cognitive impairment. Methods: We conducted a cohort study with 24-m onth follow-up using Minimum Data Set resident assessments on 1386 nur sing home residents older than 65 years with recent progression to sev ere cognitive impairment in the state of Washington. Residents within this population who underwent feeding tube placement were identified. Clinical characteristics and survival for a period of 24 months were c ompared for residents who were and were not tube fed. Results: Among t he residents with recent progression to severe cognitive impairment, 9 .7% underwent placement of a feeding tube. Factors independently assoc iated with feeding tube placement included age younger than 87 years ( odds ratio [OR], 1.85; 95% confidence interval [CI], 1.25-2.78), aspir ation (OR 5.46; 95% CI, 2.66-11.20), swallowing problems (OR, 3.00; 95 % CI, 1.81-4.97), pressure ulcer (OR, 1.64; 95% CI, 1.23-2.95), stroke (OR, 2.12; 95% CI, 1.17-2.62), less baseline functional impairment (O R, 2.07; 95% CI, 1.27-3.36), no do-not-resuscitate order (OR, 3.03; 95 % CT, 1.92-4.85), and no dementia (OR, 2.17; 95% CI, 1.43-3.22). Survi val did not differ between groups of residents with and without feedin g tubes even after adjusting for independent risk factors for feeding tube placement. Conclusions: There are specific risk factors associate d with feeding tube placement in nursing home residents with severe co gnitive impairment. However, there is no survival benefit compared wit h similar residents who are not tube fed. These prognostic data are im portant for health care providers, families, and patients making decis ions regarding enteral nutritional support in longterm care.