Study Finds High Use of Feeding Tubes in Nursing Home Patients With Dementia
About one-third of nursing home patients in the United States with advanced Alzheimer's disease or other forms of dementia are given feeding tubes, despite evidence that the tubes have no health benefits and could even be harmful, according to a study in today's Journal of the American Medical Association, the AP/Las Vegas Sun reports (Tanner, AP/Las Vegas Sun, 7/1). The study was conducted by Dr. Susan Mitchell and colleagues at the Research and Training Institute of Hebrew Rehabilitation for the Aged in Boston and surveyed about 186,000 residents in 15,135 licensed nursing homes nationwide for four months in 1999 (McNeil, New York Times, 7/2). The study found that 34% of patients with advanced dementia, or 63,101, had feeding tubes (AP/Las Vegas Sun, 7/1). The study also found that feeding tubes were more likely to be given to black and Asian nursing home residents than to whites. According to the study, patients were more likely to be given feeding tubes in urban, for-profit nursing homes; homes with a high proportion of non-white patients; and homes in Washington and the Deep South. Patients in homes in the Maine, Minnesota and New Hampshire and in nursing homes with special dementia care units were the least likely to receive feeding tubes (New York Times, 7/2). The study suggests that many for-profit nursing homes may favor using feeding tubes because Medicaid pays more for patients on tubes, and hand feeding patients is time-consuming and would require additional employees, the Boston Globe reports (Collins, Boston Globe, 7/2). The study also notes that many nursing home patients lack advanced directives or living wills, leaving medical decisions up to family members, who may favor the most aggressive course of treatment -- feeding tubes -- to prolong life (AP/Las Vegas Sun, 7/1).
The study comes "amid growing empirical data and expert opinion" that the use of feeding tubes has no health benefit and "may be associated with increased risks and discomfort," Mitchell said. Sandra Fitzler, a spokesperson for the American Health Care Association, which represents many for-profit nursing homes, disputed the study's findings and said the decision to insert a feeding tube is made on a case-by-case basis. Proponents of the feeding tubes, including many conservative religious groups, feel that the devices may prolong life and that refusing the tubes "may be viewed as consigning a patient to death," the Times reports (New York Times, 7/2). However, opponents and patient advocates argue that feeding tubes are often painful for patients and take away "much of the dignity associated with dying," according to the Globe. Mitchell stated that the federal government should reconsider its Medicaid payment schedule for feeing tubes in an effort to decrease overuse. CMS spokesperson Bill Pierce said patients who need feeding tubes often have other medical conditions that justify the higher reimbursement rate (Boston Globe, 7/2).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.