Use of Feeding Tubes Among Hospitalized Older Adults With Dementia
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".