Large number of hospitalizations could be prevented for cognitively impaired residents on feeding tubes, researchers find

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Residents of long-term care facilities who are cognitively impaired and on feeding tubes have high numbers of potentially preventable emergency room visits and hospitalizations, according to newly published research findings.

Investigators with the University of California-San Francisco analyzed Centers for Medicare & Medicaid Services data from 2006, looking at a random 5% sample of Medicare beneficiaries in skilled nursing facilities. They focused on roughly 3,500 long-stay residents with feeding tubes, categorizing them according to their level of cognitive impairment and examining how frequently they were treated in an emergency room or hospitalized.

About 44% of hospitalizations and 25% of ER visits were for ambulatory care sensitive conditions, such as urinary tract infections, the researchers found. The Agency for Healthcare Quality and Research considers hospitalizations for these conditions potentially preventable through good outpatient care.

“Our finding that one in four tube-fed NH residents require hospitalization or ED visits likely represents a substantial burden for this vulnerable cognitively impaired population,” the authors wrote. They noted that hospital trips are linked to a variety of worsening outcomes for these residents, including greater functional decline, delirium and death. These transfers also increase costs, they added.

While further investigation is needed, the researchers urged caregivers to carefully weigh the risks — and the possibility that a resident's cognitive impairments might “cloud” the true “nature and severity” of a condition — before sending residents on feeding tubes to the hospital. The presence of “even mild CI” can increase the risks of an emergency department visit for these individuals, the results indicated. 

Findings appear in BMC Geriatrics.

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