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Use of Feeding Tubes in Nursing Home Residents With Severe Cognitive Impairment

Joan M. Teno, MD, MS; Vincent Mor, PhD; Debra DeSilva, BS; Glen Kabumoto, MPH; Jason Roy, PhD; Terrie Wetle, PhD
JAMA. 2002;287(24):3211-3212. doi:10.1001/jama.287.24.3206.
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To the Editor: Many patients in the terminal phase of dementia have difficulty swallowing, with resulting weight loss and recurrent aspiration. Feeding tubes are often used for patients with advanced dementia in the hopes of delaying death or enhancing the quality of life, but the evidence supporting this practice is questionable.1,2 Although none of the 50 states prohibit the forgoing or withdrawal of a feeding tube, 15 states require a written advance directive to forgo insertion of a feeding tube.3 Aronheim et al,4 however, noted that variability in state laws did not fully explain the differences between states in use of feeding tubes. We sought other explanations for interstate variation in use of feeding tubes.

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Figure. State Variation in Feeding Tube Use Among Nursing Home Residents With Severe Cognitive Impairment
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Prepared by Brown Medical School, Center for Gerontology and Health Care Research.

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