Document Detail

Feeding tubes and the prevention or healing of pressure ulcers.
MedLine Citation:
PMID:  22782196     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The evidence regarding the use of feeding tubes in persons with advanced dementia to prevent or heal pressure ulcers is conflicting. Using national data, we set out to determine whether percutaneous endoscopic gastrostomy (PEG) tubes prevent or help heal pressure ulcers in nursing home (NH) residents with advanced cognitive impairment (ACI).
METHODS: A propensity-matched cohort study of NH residents with ACI and recent need for assistance in eating was conducted by matching each NH resident who had a feeding tube inserted during a hospitalization to 3 without a PEG tube inserted. Using the Minimum Data Set (MDS), we examined 2 outcomes: first, whether residents without a pressure ulcer developed a stage 2 or higher pressure ulcer (n = 1124 with PEG insertion); and second, whether NH residents with a pressure ulcer (n = 461) experienced improvement of the pressure ulcer by their first posthospitalization MDS assessment (mean [SD] time between evaluations, 24.6 [32.7] days).
RESULTS: Matched residents with and without a PEG insertion showed comparable sociodemographic characteristic, rates of feeding tube risk factors, and mortality. Adjusted for risk factors, hospitalized NH residents receiving a PEG tube were 2.27 times more likely to develop a new pressure ulcer (95% CI, 1.95-2.65). Conversely, those with a pressure ulcer were less likely to have the ulcer heal when they had a PEG tube inserted (OR 0.70 [95% CI, 0.55-0.89]).
CONCLUSIONS: Feeding tubes are not associated with prevention or improved healing of a pressure ulcer. Rather, our findings suggest that the use of PEG tube is associated with increased risk of pressure ulcers among NH residents with ACI.
Joan M Teno; Pedro Gozalo; Susan L Mitchell; Sylvia Kuo; Ana T Fulton; Vincent Mor
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Archives of internal medicine     Volume:  172     ISSN:  1538-3679     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-07-11     Completed Date:  2012-09-21     Revised Date:  2013-07-12    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  697-701     Citation Subset:  AIM; IM    
Center for Gerontology and Health Care Research, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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MeSH Terms
Aged, 80 and over
Cognition Disorders / epidemiology*,  physiopathology
Cohort Studies
Dementia / epidemiology*,  physiopathology
Enteral Nutrition / adverse effects*
Intubation, Gastrointestinal / instrumentation,  methods
Nursing Homes / statistics & numerical data
Pressure Ulcer / epidemiology*,  prevention & control,  therapy
Risk Factors
Severity of Illness Index
Treatment Outcome
Grant Support
1RC1AG036418-01/AG/NIA NIH HHS; K24 AG033640/AG/NIA NIH HHS; RC1 AG036418/AG/NIA NIH HHS
Comment In:
Arch Intern Med. 2012 May 14;172(9):701-3   [PMID:  22782197 ]

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