Mitchell S L, Kiely D K, Lipsitz L A
Hebrew Rehabilitation Center for Aged Research and Training Institute, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass. USA.
Arch Intern Med. 1997 Feb 10;157(3):327-32.
The provision of artificial enteral nutrition to an aged person with severe cognitive impairment is a complex dilemma in the long-term care setting.
To determine the risk factors and impact on survival of feeding tubes in nursing home residents with advanced cognitive impairment.
We conducted a cohort study with 24-month follow-up using Minimum Data Set resident assessments on 1386 nursing home residents older than 65 years with recent progression to severe cognitive impairment in the state of Washington. Residents within this population who underwent feeding tube placement were identified. Clinical characteristics and survival for a period of 24 months were compared for residents who were and were not tube fed.
Among the residents with recent progression to severe cognitive impairment, 9.7% underwent placement of a feeding tube. Factors independently associated with feeding tube placement included age younger than 87 years (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.25-2.78), aspiration (OR, 5.46; 95% CI, 2.66-11.20), swallowing problems (OR, 3.00; 95% CI, 1.81-4.97), pressure ulcer (OR, 1.64; 95% CI, 1.23-2.95), stroke (OR, 2.12; 95% CI, 1.17-2.62), less baseline functional impairment (OR, 2.07; 95% CI, 1.27-3.36), no do-not-resuscitate order (OR, 3.03; 95% CI, 1.92-4.85), and no dementia (OR, 2.17; 95% CI, 1.43-3.22). Survival did not differ between groups of residents with and without feeding tubes even after adjusting for independent risk factors for feeding tube placement.
There are specific risk factors associated with feeding tube placement in nursing home residents with severe cognitive impairment. However, there is no survival benefit compared with similar residents who are not tube fed. These prognostic data are important for health care providers, families, and patients making decisions regarding enteral nutritional support in long-term care.
在长期护理环境中，为患有严重认知障碍的老年人提供人工肠内营养是一个复杂的难题。
确定患有晚期认知障碍的养老院居民中饲管置入的风险因素及其对生存的影响。
我们进行了一项队列研究，对华盛顿州1386名65岁以上近期病情进展为严重认知障碍的养老院居民进行了为期24个月的随访，并使用最小数据集居民评估。确定该人群中接受饲管置入的居民。比较接受和未接受饲管喂养的居民的临床特征和24个月的生存期。
在近期病情进展为严重认知障碍的居民中，9.7%接受了饲管置入。与饲管置入独立相关的因素包括年龄小于87岁（比值比[OR]，1.85；95%置信区间[CI]，1.25 - 2.78）、误吸（OR，5.46；95% CI，2.66 - 11.20）、吞咽问题（OR，3.00；95% CI，1.81 - 4.97）、压疮（OR，1.64；95% CI，1.23 - 2.95）、中风（OR，2.12；95% CI，1.17 - 2.62）、基线功能损害较轻（OR，2.07；95% CI，1.27 - 3.36）、无“不要复苏”医嘱（OR，3.03；95% CI，1.92 - 4.85）以及无痴呆（OR，2.17；95% CI，1.43 - 3.22）。即使在对饲管置入的独立风险因素进行调整后，接受和未接受饲管喂养的居民组之间的生存期也没有差异。
患有严重认知障碍的养老院居民中，饲管置入存在特定的风险因素。然而，与未接受饲管喂养的类似居民相比，并无生存获益。这些预后数据对于医疗保健提供者、家庭以及在长期护理中就肠内营养支持做出决策的患者而言非常重要。
