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High Short-term Mortality in Hospitalized Patients With Advanced Dementia
Lack of Benefit of Tube Feeding
Diane E. Meier, MD;
Judith C. Ahronheim, MD;
Jane Morris, RN;
Shari Baskin-Lyons, MPH;
R. Sean Morrison, MD
Arch Intern Med. 2001;161:594-599.
Background The influence of tube feeding on survival in hospitalized patients with
advanced dementia is controversial.
Objective To assess long-term survival in an inception cohort, incident tube feeding
placement during the index hospitalization, and the influence of tube feeding
on survival in this group of patients.
Subjects and Methods Ninety-nine hospitalized patients with advanced dementia and an available
surrogate decision maker were followed up through and after the index hospitalization
for mortality and placement of a feeding tube. Other variables measured included
advance directive status, presence of a long-term primary care physician,
level of involvement of the surrogate decision maker, admitting diagnosis,
prior hospitalizations, comorbidities, and diagnosis related group diagnostic
category.
Results A new feeding tube was placed in 50% (51/99) of the study patients during
the index hospitalization, 31% (31/99) left the hospital without a feeding
tube, and 17% (17/99) were admitted with a feeding tube already in place.
By stepwise logistic regression analysis, predictors of new feeding tube placement
included African American ethnicity (odds ratio, 9.43; 95% confidence interval,
2.1-43.2) and residence in a nursing home (odds ratio, 4.9; 95% confidence
interval, 1.02-2.5). Median survival of the 99 patients was 175 days. Eighty-five
(85%) survived the index hospitalization, and 28 (28%) were still alive at
last follow-up, a range of 1.3 to 4.2 years after enrollment in the study.
Tube feeding was not associated with survival (P
= .90). An admitting diagnosis of infection was associated with higher mortality
(odds ratio, 1.9; 95% confidence interval, 1.01-3.6).
Conclusions In this cohort of hospitalized patients with advanced dementia, risk
of receiving a new feeding tube is high, associated with African American
ethnicity, and prior residence in a nursing home, and has no measurable influence
on survival. With or without a feeding tube, these patients have a 50% six-month
median mortality.
From the Department of Geriatrics and Adult Development, the Lilian
and Benjamin Hertzberg Palliative Care Institute, Mount Sinai School of Medicine
(Drs Meier and Morrison and Mss Morris and Baskin-Lyon), the Eileen E. Anderson
Section of Geriatrics, St Vincent's Hospital and Medical Center (Dr Ahronheim),
and the New York Medical College (Dr Ahronheim), New York, NY.
Corresponding author: Diane E. Meier, MD, Box 1070, Mount Sinai School
of Medicine, New York, NY 10029 (e-mail: diane.meier{at}mssm.edu).
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Allan S. Brett, Diane E. Meier, and R. Sean Morrison
Arch Intern Med. 2001;161(19):2385-2386.
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