Hospitals that insert feeding tubes into patients with advanced dementia and discharge them to skilled nursing homes may, in fact, cause harm by making these patients more susceptible to pressure ulcers, according to a review of Medicare claims.
"We know there is no survival difference whether you put in a feeding tube or you don't put in a feeding tube," says Joan M. Teno, MD the lead author of the research published in Monday's edition of the Archives of Internal Medicine, who has studied the issue for more than 10 years. Now, evidence of nine years of Medicare claims data indicates feeding tubes actually doubled the chance of a pressure ulcer in these patients.
It had been believed that in patients with dementia, who often have eating disorders, nutritional imbalances cause and exacerbate pressure ulcers and prevent their healing. Feeding tubes delivering protein supplements were presumed to have been helpful. But prior studies were inconclusive and Teno's study revealed exactly the opposite.
Of those nursing home patients with dementia who were hospitalized, 35.6% of those who received a feeding tube during their stay developed a stage 2 or higher pressure ulcer on return to the nursing home, compared with 19.8% of hospitalized patients who did not get a feeding tube. Risk adjusted, Teno says, pressure ulcer risk was 2.27 times higher with a feeding tube than without it.