DOES ARTIFICIAL ENTERAL NUTRITION PROLONG THE SURVIVAL OF INSTITUTIONALIZED ELDERS WITH CHEWING AND SWALLOWING PROBLEMS

Background. There is a lack of prognostic data regarding tube feeding of institutionalized elderly people. The objective of this study was t o determine the impact of feeding tubes on the survival of nursing hom e residents with chewing and swallowing problems, and to follow the co urse of the tube-fed residents over one year. Methods. We conducted a cohort study with 12-month follow-up using Minimum Data Set resident a ssessments from 1991. Participants included 5,266 nursing home residen ts over the age of 65 with chewing and swallowing problems living in 2 72 Washington state nursing homes. Residents who had a feeding tube we re identified. Baseline clinical characteristics and 12-month survival were compared for residents with and without feeding tubes. The propo rtion of tube-fed residents who became tube-free during the follow-up period was determined, and clinical features that predicted this outco me were examined. Results. Among the residents with chewing and swallo wing problems, 10.5% had a feeding tube. After adjusting for potential confounding covariates, tube-fed residents had a significantly higher one-year mortality rate than those without feeding tubes (risk ratio, 1.44; 95% CI, 1.17-1.76). Of the 430 residents with feeding tubes who survived the follow-up period, 25.1% became free of a feeding tube. A ge less than 87 years was associated with a significantly greater like lihood of becoming tube-free (odds ratio, 1.66; 95% CI, 1.03-2.6). Con clusions. Residents selected for feeding tube placement have poorer su rvival after one year than residents who are not tube-fed. However, th e feeding tubes are removed in a significant proportion of residents w ho survive one year. Residents with a potentially reversible condition , for whom the feeding tubes are a temporary intervention, need to be identified.