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Dementia: Feeding tubes may add to risk of bed sores

 PEG or Percutaneous endoscopic gastric feeding tubes, long assumed to help bed-bound dementia patients stave off or overcome bed sores/pressure ulcers, may instead make the wounds more likely to develop or not improve, according to a study.
We see a substantial risk of people developing a stage II and higher pressure ulcer. 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 cognitive impairment.”
Dr Joan Teno, MD, MS, the study’s lead author, is a gerontologist and professor of health services, policy and practice in the Public Health Program at Brown University in Providence, R.I. In a news release she said:, “This study provides new information about the risks of feeding tube insertion in people with advanced cognitive impairment.”

Researchers found that among patients who did not start with an ulcer (bed sore), 35.6% of those with a feeding tube ended up with at least a stage II ulcer, compared with 19.8% of patients without a feeding tube.

The researchers found that the chance of getting an ulcer was 2.27 times higher for people with feeding tubes than for those without.
The risk of developing a more serious stage IV ulcer was 3.21 times higher for those with feeding tubes.

Among patients who already had an ulcer, the researchers found that 27.1% of patients with a feeding tube experienced short-term improvement, while 34.6% of those without a feeding tube experienced healing in a comparable time frame.

In a previous survey, three-quarters of physicians thought the nutrition delivered by feeding tubes would help patients resist ulcers. Perhaps with the idea of such a benefit in mind, physicians frequently do not discuss the risks of feeding tubes with patient families, Teno has found.

The study did not gauge how feeding tubes could cause ulcers, but Teno and her co-authors posited that because many patients become agitated by having a tube, they are often physically restrained and sedated with drugs.

The new findings should lead clinicians and families to ask more questions about whether feeding tubes are appropriate treatments, compared with careful hand feeding, for patients who have become so cognitively impaired that they can no longer eat independently, Teno said.


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