Use of Feeding Tubes Among Hospitalized Older Adults With Dementia
Notice bibliographique
Résumé
Importance: Although dementia is a contraindication for feeding tube placement, guidelines recommending against its use are inconsistently followed, and factors associated with its use are unclear. Objective: To describe the incidence of feeding tube placement among hospitalized older adults (aged ≥65 years) with dementia and their health outcomes during and after hospitalization and to identify factors associated with placement of feeding tubes (ie, gastrostomy, gastrostomy-jejunostomy, and jejunostomy tubes). Design, Setting, and Participants: This population-based retrospective cohort study was conducted using a linked database in Ontario, Canada. Older adults who were diagnosed with dementia prior to a hospitalization between April 1, 2014, and March 31, 2018, were included. Data analyses were completed between October 2021 and November 2024. Exposures: Sociodemographic characteristics, health profiles, functional status, and advanced directives. Main Outcomes and Measures: Whether individuals received a feeding tube insertion (ie, gastrostomy, gastrostomy-jejunostomy, or jejunostomy tube), as identified by Ontario Health Insurance Plan billing codes. Results: Among 143 331 older adults with dementia (83 536 [58.3%] female; mean [SD] age, 83.8 [7.5] years), 1312 (0.9%) received a feeding tube in hospital and 142 019 (99.1%) did not. During hospitalization, feeding tube recipients stayed longer in hospital (mean [SD] stay, 65.6 [120.8] vs 14.8 [35.2] days for nonrecipients) and were more likely to be admitted to the intensive care unit (557 [42.5%] vs 14 423 [10.2%] of nonrecipients) or to die in hospital (294 [22.4%] vs 14 698 [10.3%] of nonrecipients). Within 1 year of discharge, 509 of 1018 feeding tube recipients (50.0%) died compared with 36 162 of 127 321 nonrecipients (28.4%). Among recipients of home care and long-term care residents, regression modeling showed that having swallowing problems (odds ratio [OR], 2.22; 95% CI, 1.99-2.49) and greater functional impairments (OR, 2.75; 95% CI, 1.80-4.20) were associated with increased odds of receiving a feeding tube, while being female (OR, 0.66; 95% CI, 0.52-0.84), older (OR for every 5-year increase in age, 0.75; 95% CI, 0.70-0.81), having a do-not-resuscitate directive (OR, 0.38; 95% CI, 0.31-0.47), and living in rural settings (OR, 0.38; 95% CI, 0.22-0.66) were associated with reduced odds. Conclusions and Relevance: In this cohort study of hospitalized individuals with dementia, feeding tube insertion was not associated with improved survival or postdischarge outcomes. Factors that were (or were not) associated with feeding tube placement were sometimes misaligned with best practice guidelines. Goals of care conversations, alternative intervention options, and improved clinical protocols are recommended.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».