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Too Many With End-Stage Dementia Get Feeding Tubes
Date:2/9/2010

Study found larger, for-profit hospitals more likely to insert them

TUESDAY, Feb. 9 (HealthDay News) -- Larger hospitals and those that are set up to make a profit are more likely to use feeding tubes in patients with advanced dementia, despite evidence that the practice does not prolong life or help with bed sores and other problems.

"Our results suggest that decisions about feeding tubes are more about which hospital you go to than a decision-making process that really elicits and supports patient choice," said Dr. Joan Teno, whose study appears in the Feb. 10 issue of the Journal of the American Medical Association. "We have good evidence from surveys with people in nursing homes and of family members of people with dementia that the majority would rather die than receive a feeding tube."

According to prior research, more than one-third of U.S. nursing home residents with advanced dementia have feeding tubes. About two-thirds of these have the tube inserted during an acute-care hospitalization.

Teno and her colleagues looked at a sample of Medicare claims filed for nursing home residents who had been admitted to acute-care hospitals with advanced dementia between 2000 and 2007.

On average, feeding tubes were placed in 7.9 per 100 patients, with the variation ranging from 0 to 38.9 per 100 hospitalizations.

For-profit hospitals, along with facilities that had 310 beds or more and those that had the most use of intensive care during the last six months of a person's life, were more likely to use feeding tubes.

Part of the reason for the differences probably has to do with the health-care system, said Teno, who is a professor of community health at the Warren Alpert Medical School of Brown University in Providence, R.I.

"We have really two separate financing systems for people who are in nursing homes," she explained. "We have Medicaid that pays for custodial care and
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