Tube Feeding Preferences Among Nursing Home Residents

Abstract

OBJECTIVE:To determine the preferences of nursing home residents regarding the use of tube feedings and to characterize the clinical, functional, and psychosocial factors that are associated with preferences. DESIGN:In-person survey.SETTING: Forty-nine randomly selected nursing homes. PATIENTS/PARTICIPANTS:Three hundred seventy-nine randomly selected, decisionally capable, nursing home residents. MAIN RESULTS:Thirty-three percent of participants would prefer tube feedings if no longer able to eat because of permanent brain damage. Factors positively associated with preferences for tube feedings include male gender, African-American race, never having discussed treatment preferences with family members or health care providers, never having signed an advance directive, and believing that tube feeding preferences will be respected by the nursing home staff. Twenty-five percent of the participants changed from preferring tube feedings to not preferring tube feedings on learning that physical restraints are sometimes applied during the tube feeding process.CONCLUSIONS: Demographic and social factors are associated with preferences for tube feedings. The provision of information about the potential use of physical restraint altered a proportion of nursing home residents' treatment preferences.

"Lost to Follow-up": Ethnic Disparities in Continuity of Hospice Care at the End of Life

“…Extensive data demonstrate that African American patients are less willing to give up life-sustaining treatment. [23][24][25][26][27] It is possible, therefore, that the African American patients in this study had goals for care and preferences for treatment that were less consistent with hospice care and that these goals and preferences made African Americans less likely to re-enroll.…”

Preferences of older African-Americans for long-term tube feeding at the end of life

“…These include the importance of quality of life and longevity. Published studies of older adults reveal only a minority would opt for PEG tube feedings in the setting of severe limitation in function (Danis et al, 1994;Gjerdingen, 1999;Murphy & Santilli, 1998;O'Brien et al, 1997). Several subjects in our study did indicate that quality of life would be their primary guide to deciding about a PEG tube.…”

Correlates associated with the desire for PEG tube placement at the end of life among community-dwelling older Mexican Americans: a pilot study

“…In addition, African Americans tend to prefer life sustaining treatments with Fairrow and colleagues finding religion was an important mediator in the decision for this population to forgo PEG placement. Some elder African Americans refer specifically to a potentially better life after death, therefore allowing them to feel more comfortable rejecting the PEG intervention at the end of life [9]. Older Mexican Americans who are not actively religious, and therefore not having the same spiritual orientation as those more religious, might conversely see the need to prolong their lives as long as possible.…”

“…Weighing the possible risks and benefits associated with PEG tube placement is further complicated by evidence of ethnic differences in its use. Older African American and Hispanic individuals are more likely to receive PEG placement than older non-Hispanic White adults [8,9] and are more likely to indicate tube feeding would be a personal choice in the event of a life-threatening illness or brain damage [10,11].…”

“…Some studies report more positive attitudes than non-Hispanic Whites toward life support in general [12][13][14], while other studies report no attitudinal differences regarding end-of-life care [15,16]. Although there appears to be no difference in rates of PEG treatment between Hispanics and non-Hispanic Whites in Veterans Administration hospitals, [17] another study found greater use of tube feeding among Hispanic nursing home residents [9]. Findings from a single qualitative study of community residing older adults suggest that Hispanic women are likely to reject tube feeding [18].…”