This decline parallels the emergence of research, 1 , 2 expert opinion, and recommendations by national organizations 3 discouraging this practice. Insertion rates declined between and among white residents 8. However, black residents were more likely to get tube fed in ARR, 4. Moreover, the reported number of residents with advanced dementia and eating problems declined from to , reflecting the shifting composition of US nursing homes, such that patients with chronic illnesses, including dementia, are being increasingly maintained in the community with greater access to services. Critical revision of the manuscript for important intellectual content:
The number of reported feeding tube insertions are specific to the cohort definitions. This decline parallels the emergence of research, 1 , 2 expert opinion, and recommendations by national organizations 3 discouraging this practice. Power was inadequate to examine factors associated with tube feeding use. Racial disparities were examined because black race has been strongly associated with greater feeding tube use. The National Institutes of Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Zylke, MD, Deputy Editor. Second, residents meeting these criteria who became totally dependent for eating on any MDS assessment completed within days after their initial assessment were identified. Dr Gozalo and Mr Servadio had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analyses. Poisson regression models were used to estimate the linear time trend of annual changes in insertion rates using all years of data, controlling for age, sex, race white, black, and other , and stroke. To ensure the message from existing evidence and expert recommendations is disseminated and disparities are reduced, fiscal and regulatory policies are needed that discourage tube feeding and promote a palliative approach to feeding problems in patients with advanced dementia. These characteristics were similar across years. Acquisition, analysis, or interpretation of data: Results Between and , 71 residents with advanced dementia and recent dependence for eating were identified with the following characteristics: The proportion of residents receiving feeding tubes over the next 12 months declined from Study concept and design: Moreover, the reported number of residents with advanced dementia and eating problems declined from to , reflecting the shifting composition of US nursing homes, such that patients with chronic illnesses, including dementia, are being increasingly maintained in the community with greater access to services. Separate models were generated for white and black residents controlling for age, sex, and stroke. Drafting of the manuscript: Data were derived from federally mandated Minimum Data Set MDS assessments completed quarterly, as required, on all residents in US nursing homes between January 1, , and October 31, Administrative, technical, or material support: Third, the proportion of residents with advanced dementia and recent eating dependency who had a new feeding tube indicated on any MDS assessment during the next 12 months was determined. Conflict of Interest Disclosures: Feeding tube use decreased across racial groups, but remained relatively higher among black residents, consistent with prior research. Critical revision of the manuscript for important intellectual content: The actual number of tubes inserted in all US residents with advanced dementia is likely much higher. However, black residents were more likely to get tube fed in ARR, 4. Multimedia Over the last 2 decades, research has failed to demonstrate benefits of tube feeding in patients with advanced dementia.
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