Tube Feeding in US Nursing Home Residents With Advanced Dementia, 2000-2014

feeding tubes decreased by approximately 50% between 2000 and 2014.This decline parallels the emergence of research, 1,2 expert opinion, and recommendations by national organizations 3 discouraging this practice.Feeding tube use decreased across racial groups, but remained relatively higher among black residents, consistent with prior research. 2,4 This study has limitations.The number of reported feeding tube insertions are specific to the cohort definitions.The actual number of tubes inserted in all US residents with advanced dementia is likely much higher.Moreover, the reported number of residents with advanced dementia and eating problems declined from 2000 to 2014, reflecting the shifting composition of US nursing homes, such that patients with chronic illnesses, including dementia, are being increasingly maintained in the community with greater access to services. 6However, given the analyses applied the same definitions to the numerator and denominator in each year, the comparison of annual insertion rates is reasonable.Power was inadequate to examine factors associated with tube feeding use.To ensure the message from existing evidence and expert recommendations is disseminated and disparities are reduced, fiscal and regulatory policies are needed that discourage tube feeding and promote a palliative approach to feeding problems in patients with advanced dementia.