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For Dementia Patients,
Feeding Tubes May Increase Bed Sores
Source: Brown University
May 14, 2012
Feeding
tubes increase the risk of bed sores in bedridden
dementia patients, according to a new study.
The finding challenges the long-held belief that
providing nutrition through feeding tubes helps
prevent bed sores or helps promote their healing in
this group of patients, the authors of the Brown
University-led study said.
The researchers did not look at how feeding tubes
could cause bed sores (also called pressure ulcers),
but they noted that feeding tubes can cause agitation
in patients, who then have to be restrained and
sedated. Feeding tubes also may increase the risk of
diarrhea.
Together, these factors may cause and worsen bed
sores, the researchers said.
The researchers examined data from nursing homes and
Medicare claims in order to compare thousands of
dementia patients. Among patients who did not
initially have a bed sore, 35.6 percent with a feeding
tube ended up with at least a stage 2 bed sore,
compared with 19.8 percent of patients without a
feeding tube.
A stage 2 bed sore is an open sore in the upper layer
of the skin. A stage 4 bed sore is the most serious
type.
After making statistical adjustments, the researchers
concluded that patients with a feeding tube were 2.27
times more likely to develop a bed sore than those
without a feeding tube. The risk of developing a stage
4 bed sore was 3.21 times higher for those with a
feeding tube.
Among patients who already had a bed sore, short-term
improvement in the sore occurred in 27.1 percent of
patients with a feeding tube and in 34.6 percent of
those without. Patients without a feeding tube were
0.7 times more likely to have an improvement in a sore
than those with one, the researchers determined.
The study was published May 14 in the journal Archives of Internal
Medicine.
"This study provides new information about the risks
of feeding tube insertion in people with advanced
[dementia]," lead author Dr. Joan Teno, a
gerontologist and professor of health services, policy
and practice in the Public Health Program at Brown,
said in a university news release.
"We see a substantial risk of people developing a
stage 2 and higher [bed sore]," she said. "We believe
these risks should be discussed with family members
before a decision is made to insert a feeding tube in
a hospitalized nursing home resident with advanced
[dementia]."
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