Effectiveness of feeding tubes in nursing home residents with swallowing disorders

Background: Among nursing home residents who stop eating, a common decision for residents, caregivers, and families is the decision to begin tube feed ing. This study examines the effectiveness of feeding tubes at reducing mor tality among nursing home residents with swallowing disorders and feeding d isabilities. Methods: Data from a version of the Minimum Data Set+ (MDS+) e ncompassing three different states from calendar years 1993 and 1994 were a nalyzed. Residents were included in the study if they were not totally depe ndent on staff for eating upon their first assessment but became totally de pendent on staff for eating and had a swallowing disorder at some point dur ing their nursing home stay. We used a proportional hazard regression to ex amine the relationship of feeding tubes with mortality after total eating d ependence occurred. Results: Unadjusted Kaplan-Meier curves found that thos e with feeding tubes were less likely to die than comparable residents with out feeding tubes (p <.001). Estimated survival at 1 year was 39% for those without feeding tubes and 50% for those with feeding tubes. The multivaria te results indicated that feeding tubes were associated with a reduced risk of death (risk ratio, 0.71; 95% confidence interval, 0.59, 0.86). Conclusi ons: This study provides evidence that tube feeding can be life-prolonging, even if the gain in life is not substantial. Such information can be usefu l to nursing home staff, residents, and families when trying to decide whet her to place a feeding tube in a resident with swallowing disorders and eat ing disabilities.