Table 1 – Detailed Description of Research Studies for Tube Feeding
# Article Objectives Study Design Main Findings Discussion
Mitchell SL et al. To determine the: Cohort study with 12- Residents were placed in one of two arms: those “Residents selected for
1 Impact of feeding tubes month follow-up. who had a feeding tube (case group) and those who feeding tube placement have
“Does artificial enteral on the survival of Setting: 272 nursing did not have a feeding tube (control group). poorer survival after one year
nutrition prolong the nursing home residents homes in Washington 551 (10.5%) of 5,266 residents had feeding tubes. than residents who are not
survival of with chewing and State. 121 (22.0%) died during the 12-month follow-up tube-fed. However, the
institutionalized elders swallowing problems Time period: 1991 with period. feeding tubes are removed in
with chewing and and to follow the course 12-month follow-up. 108 (25.1%) of 430 surviving residents became a significant proportion of
swallowing problems?” of the tube-fed residents Study population: free and remained free of the feeding tube residents who survive one
over one year. Size: N=5,266 during the 12-month follow-up period. year. Residents with a
Journal of Gerontology: residents with chewing The only clinical factor significantly associated potentially reversible
Medical Sciences and swallowing with feeding tube removal was age 65 years old. living (ADL) limitations and > 60% of each
cohort had severe cognitive impairment.
Feeding tubes were associated with a reduced risk
of death (RR: 0.71; 95% CI: 0.58-0.86).
39% of those without feeding tubes were alive at
one year, compared to 50% of those without feeding
tubes.
Residents using feeding tubes have a
significantly higher survival than those not using
feeding tubes (p 86 years in older residents with severe
“Tube feeding in nursing Selected demographic based study. (N=346, 16.0%) (p 70 years old. results further strengthen the
Digestive Diseases and Long-term survival of nursing home. Prior to PEG placement, 23 (50%) residents view that because of the poor
Sciences PEG tube recipients. Time period: August received oral feeding, 19 (41%) received duodenal outcome, the indication for
1988 – November 1990. or nasogastric tube feedings, and four (9%) received PEG placement needs to be
1994;39(4):738-43. Study population: feeding defined simply as gastrointestinal. redefined.”
Size: N=46. 22 (47.8%) residents had total impairment functional
status (grade IV).
19 (41.0%) residents were no-code at the time of
PEG tube placement, increasing to 33 (72.0%)
during the follow-up period.
Tube complications requiring hospital care (e.g., ER,
outpatient, or admission) occurred in 16 (34.7%)
residents.
Aspiration pneumonia occurred in 20% of residents
after PEG placement but there was no correlation
between aspiration pneumonia and the feeding
method.
27 (58.7%) residents died during follow-up; 20%
dying within one month of PEG tube placement.*
Subsequent to PEG placement, all residents were
administered commercially available formulas. Daily
caloric intake ranged from 1,520 – 2,290 cal/day.
Albumin >3.5 g/dl at PEG placement (or afterwards)
was associated with improved survival (p 60. In all three groups of subjects (N=189), one of the because oral hygiene is often
Gender: 100% male. best predictors of aspiration pneumonia was being neglected in these residents
tube-fed before pneumonia (OR: 3.03; 95% CI: and their salivary flow is often
1.003-9.161; p=0.0494). reduced.”
Table 1 – Detailed Description of Research Studies for Tube Feeding
# Article Objectives Study Design Main Findings Discussion
Cogen R et al. To determine the: Retrospective review of All residents were transferred from an acute care Providing nutrition to nursing
11 Incidence of medical records of hospital with medical records to the nursing home. home residents who are
“Complications of complications, jejunostomy tube Information on the following variables was collected: unable to eat is difficult. Tube
jejunostomy tube especially aspiration residents. age, race, gender, diagnosis, reason for jejunostomy feeding is one way to provide
feeding in nursing pneumonia, associated Setting: 102-bed skilled tube placement, complications, jejunostomy tube nutrition in this group of
facility patients” with jejunostomy tube nursing facility (SNF). type, and disposition. residents. Tube feeding via a
feeding in a skilled Time period: January 27 (61.4%) residents were diagnosed with a gastrostomy tube is a
American Journal of nursing facility over a 1986 – March 1990. neurological disorder while 17 (38.6%) were common method to provide
Gastroenterology four-year period. Study population: diagnosed with a non-neurological disorder. enteral nutrition, but
Size: N=44. Mean duration of jejunostomy tube use in the SNF aspiration pneumonia is a
1991;86(11):1610-13. Mean age: 71.8. was 31.5 days (range 2-145). common adverse event
Gender: 52% female. Two deaths were related to jejunostomy feeding associated with this type of
Race: 77% white. (one case of an intra-abdominal abscess at the tube tube feeding. This has led to
site and one case of aspiration pneumonia). a search for a more effective
Seven (15.9%) residents suffered from aspiration method of tube feeding.
pneumonia (one patient suffered two episodes). Theoretically, jejunostomy
History of aspiration pneumonia prior to jejunostomy tubes are able to provide
tube placement was significantly associated with enteral nutrition with less
subsequent aspiration (p<0.05). incidence of aspiration
pneumonia since the meal is
Age, mental status, and reason for tube placement
infused more distally into the
were not significantly associated with aspiration
GI tract. This study reports
pneumonia.
an incidence of 15.9% for
36 (81.8%) residents experienced at least one
aspiration pneumonia, which
complication associated with jejunostomy tube
is similar to gastrostomy tube
feeding.
feeding. The authors
conclude that jejunostomy
tube feeding “does not protect
against aspiration pneumonia
in residents known to
aspirate, and that the high
overall complication rate
makes its use problematic in
the SNF setting.”
Table 1 – Detailed Description of Research Studies for Tube Feeding
# Article Objectives Study Design Main Findings Discussion
Leff B et al. To determine: Retrospective, Seven (46.6%) of 15 residents were weaned from Nursing home residents with
12 Whether tube-fed descriptive analysis. tube feeding and were able to begin natural feeding. feeding tubes comprise a
“Discontinuing feeding nursing home residents Setting: 126-bed Jenkins A history of multi-infarct dementia and a presence of heterogeneous population.
tubes in a community can be retrained to eat Memorial Home in the an indwelling Foley catheter on admission seemed Nearly half of those admitted
nursing home” orally and thereby Baltimore, MD area. to be associated with weaning, but no statistical to this study site were
discontinue tube Time period: January, analysis was conducted. retrained to take food by
Gerontologist feeding. 1985 – January, 1992. A trend was noted between shorter weaning periods mouth and have their feeding
Study population: and shorter tube duration (i.e., the amount of time tubes removed. Some
1994;34(1):130-33. Size: N=15. tube feeding was in place prior to starting oral residents can eventually re-
feeding). learn to feed themselves.
Several successfully weaned residents were never
expected to do so.
Mortality ranged from 88 to 1,447 days with three
(42.9%) of seven residents dying within 12 months
of feeding tube removal.
Graham S et al. To describe and compare: Prospective, randomized, The study population consisted of two distinct This study revealed “no
13 Patient outcomes when non-blinded crossover patient populations. observed differences in
“Percutaneous feeding percutaneous feeding study of six months N=15: severe brain injury group. clinical outcomes in long-term
tube changes in long- tubes were changed routine monthly changes N=11: residents with a variety of other illnesses. care facility residents when
term-care facility routinely each month or compared with six 12 (50%) of 24 residents were initially randomized to feeding tubes were changed
patients” only when feeding tubes months PRN changes. the PRN cohort. routinely” vs. PRN changes.
were changed as Setting: 461-bed LTC 63 tube feed changes took place in the PRN
Infection Control and necessary (PRN). facility. group and 176 took place in the routine monthly However, the PRN cohort did
Hospital Epidemiology Time period: Not change cohort (p=0.0005); this was the only require significantly fewer
reported. significant difference between the two groups. changes (63 vs. 176). This
1996;17(11):732-36. Study population: Differences in stomal site infections, temperature could lead to decreased cost,
Size: N=26*. elevations, episodes of emesis, or antibiotic courses less patient discomfort, and
Mean age: 61.5 years. were not significantly different between the two better use of nursing home
groups. staff time on other patient
* Two residents from the “other care activities.
unit group” died at three days
and three months after initial
randomization.
Table 1 – Detailed Description of Research Studies for Tube Feeding
# Article Objectives Study Design Main Findings Discussion
Graham S et al. To determine: Randomized control trial Study design: This study showed no
14 Whether more with two study periods. First period: residents were randomized to difference in adverse
“Frequency of changing prolonged intervals Setting: 417-bed LTC enteral bag and tubing changes at 24, 48, and outcome in residents who had
enteral alimentation between bag and tubing facility in Manitoba, 72 hours. This period continued for six months. their feeding tubes and bags
bags and tubing, and changes adversely Canada. Second period: residents were randomized to changed every 72 hours
adverse clinical affected patient health. Time period: First study receive bag and tubing changes either daily or compared to residents who
outcomes in patients in period = six months; every 72 hours. This period had a duration of had their tubes and bags
a long term care facility” second study period = three months. changed every 24 hours.
three months. In residents randomized to either study: eight had
Canadian Journal of Study population: gastrostomy tubes, three had nasogastric tubes, and According to the authors, “this
Infection Control Size: First study period one had a jejunostomy tube. Ten were gravity-fed suggests that prolonging the
N=11; second study and two were pump fed. interval between changing
1993;8(2):41-43. period N=12. 11 residents were randomized (2-24 hour changes, enteral feeding tubes and
3-48 hour changes, 6-72 hour changes) in the first bags from 24 to 72 hours for
study period. residents in long term care
12 residents were randomized (6-24 hour changes facilities [may be]
and 6-72 hour changes) in the second study period. appropriate.”
When 24-hour tube change was compared to 72-
hour tube change, there were no significant It should be noted that the
differences in proportion of days with gastrointestinal sample size in this study was
symptoms alone, or combined with fever. rather small, that no
mycological testing was done,
and that details of the
statistical analysis were not
reported. Therefore, the
results of this trial need to be
interpreted cautiously.
Table 2 – Topic Outline
Article Title Year Study type Topics Reviewed
Cross-sectional
Feeding Tubes
Retrospective
Risk Factors
Randomized
Prospective
Removal of
Morbidity
Mortality/
Other
“Tube feeding in nursing home residents with
severe and irreversible cognitive impairment”
by Gessert CE et al.
2000
“Effectiveness of feeding tubes in nursing
home residents with swallowing disorders”
by Rudberg MA et al.
2000
“Predictors of aspiration pneumonia: How
important is dysphasia?”
by Langmore SE et al.
1998
“Does artificial enteral nutrition prolong the
survival of institutionalized elders with
chewing and swallowing problems”
by Mitchell SL et al.
1998
“The risk factors and impact on survival of
feeding tube placement in nursing home
residents with severe cognitive impairment”
by Mitchell SL et al.
1997
“Audit of percutaneous endoscopic
gastrostomy in long-term enteral feeding in a
nursing home”
by Bourdel-Marchasson I et al.
1997
“Percutaneous feeding tube changes in long-
term-care facility patients”
by Graham S et al.
1996
“Pilot study of 12-month outcomes of nursing
home patients with aspiration on
videofluoroscopy”
by Croghan JE et al.
1994
“Long-term follow-up of consequences of
percutaneous endoscopic gastrostomy (PEG)
tubes in nursing home patients”
by Kaw M, Sekas G
1994
“Discontinuing feeding tubes in a community
nursing home”
by Leff B et al.
1994
Table 2 – Topic Outline
Article Title Year Study type Topics Reviewed
Cross-sectional
Feeding Tubes
Retrospective
Risk Factors
Randomized
Prospective
Removal of
Morbidity
Mortality/
Other
“Frequency of changing enteral alimentation
bags and tubing, and adverse clinical
outcomes in patients in a long term care
1993
facility”
by Graham S et al.
“Prolonged tube feeding in long-term care:
nutritional status and clinical outcomes”
by Henderson CT et al
1992
“Complications of jejunostomy tube feeding in
nursing facility patients”
by Cogen R et al.
1991
“Malnutrition in tubefed nursing home patients
with pressure sores”
by Breslow RA et al.
1991