Feeding tubes may not help in severe dementia, yet use varies widely

Feeding tubes may neither delay death nor improve quality of life for nursing home patients with severe dementia, yet the use of feeding tubes varies widely. In some states the use of feeding tubes is more than 10 times the rate of other states, according to a new study by Brown University researchers.

"Such striking variation calls for increased communication among physicians, patients prior to their developing this level of dementia, families and nursing home regulators," said lead author Joan Teno, M.D., professor of community health and medicine at the Brown Medical School. The study appears as a research letter in the June 26, 2002, issue of the Journal of the American Medical Association.

Teno and colleagues analyzed records for 1999 from the Minimum Data Set, a national repository of nursing home data. The data set included information on feeding tube use among 385,741 U.S. nursing home residents with severe dementia.

Nationwide, about 18 percent of nursing home residents with severe dementia had a feeding tube, with use rates varying from 3.8 percent in Nebraska to 44.8 percent in the District of Columbia. The only identified factor that was closely associated with the interstate differences was physician use of "do-not-resuscitate orders" (DNRs). For each 10-percent increase in the use of DNR orders in a state, there was a 4.5-percent decrease in feeding tube use.

"A DNR order is about resuscitation and should not influence decisions about whether to use a feeding tube," said Teno. "It may be that doctors are giving up on their patients with DNRs, so don't recommend further treatment. This underscores the need for greater discussion about decisions to use feeding tubes. That use shouldn't be just an automatic process. A careful discussion is especially important for patients who are severely demented, since medical evidence questions whether feeding tubes improve the quality or even the length of life. These should be broad d

Contact: Scott Turner
Brown University

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