Mitchell et al identified risk factors for placement of a feeding tube in a nursing home resident with severe cognitive impairment. The authors are from Beth Deaconess Medical Center and Harvard Medical School in Boston.


Patient selection: nursing home resident > 65 years of age with severe cognitive impairment


Risk factors associated with feeding tube placement:

(1) age < 87 years

(2) history of aspiration

(3) difficulty swallowing

(4) history of stroke

(5) presence of a pressure ulcer


Aspiration had the highest odds ratio for placement (5.5).


Factors making feeding tube placement less likely:

(1) moderate or severe functional impairment

(2) Do-not-resuscitate order

(3) dementia


Placement of a feeding tube was not associated with improved survival.


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