Table 3.
Individual Characteristics of Nursing Home Residents With Advanced Cognitive Impairment Associated With Feeding Tube Insertion
| No. (%) |
||||
|---|---|---|---|---|
| Characteristics | Admissions (n = 280 869) | Feeding Tube Insertions (n = 19 847) | Unadjusted Feeding Tube Insertion Rate per 100 Admissions (95% CI) | Feeding Tube Insertion With Hospital and Patient Characteristics, AOR (95% CI) (n = 275 410)a |
| Sex | ||||
| Men | 95 260 (33.9) | 7365 (37.1) | 7.7 (7.6–7.9) | 1 [Reference] |
| Women | 185 585 (66.1) | 12 482 (62.9) | 6.7 (6.7–6.8) | 0.88 (0.85–0.91) |
| Race/ethnicityb | ||||
| White | 222 832 (79.4) | 12 215 (61.6) | 5.5 (5.4–5.6) | 1 [Reference] |
| Black | 39 716 (14.2) | 5593 (28.2) | 14.0 (13.7–14.4) | 1.96 (1.89–2.04) |
| Hispanic | 13 509 (4.8) | 1556 (7.9) | 11.5 (11.0–12.1) | 1.36 (1.27–1.46) |
| Other | 4507 (1.6) | 461 (2.3) | 10.2 (9.3–11.1) | 1.42 (1.28–1.59) |
| Age, y | ||||
| 66–79 | 81 600 (29.1) | 6537 (32.9) | 8.0 (7.8–8.2) | 1 [Reference] |
| 80–84 | 66 739 (23.8) | 47 770 (24.0) | 7.1 (6.9–7.3) | 1.00 (0.96–1.04) |
| 85–89 | 69 729 (24.8) | 4686 (23.6) | 6.7 (6.5–6.9) | 1.00 (0.95–1.04) |
| ≥90 | 62 801 (22.4) | 3854 (19.4) | 6.1 (5.9–6.3) | 0.90 (0.86–0.94) |
| Medical history | ||||
| Cancer | 11 471 (4.1) | 736 (3.7) | 6.4 (6.0–6.9) | 0.86 (0.79–0.93) |
| COPD | 39 226 (14.0) | 2469 (12.4) | 6.3 (6.0–6.5) | 0.89 (0.85–0.93) |
| Stroke | 70 567 (25.1) | 5840 (29.4) | 8.3 (8.1–8.5) | 1.16 (1.12–1.20) |
| Hip fracture | 19 785 (7.0) | 1263 (6.4) | 6.4 (6.0–6.7) | 1.00 (0.94–1.06) |
| Advance directives | ||||
| Living will | 35 609 (12.7) | 1447 (7.3) | 4.1 (3.9–4.3) | 0.75 (0.70–0.79) |
| Durable power of attorney for health care | 79 408 (28.3) | 3753 (18.9) | 4.7 (4.6–4.9) | 0.88 (0.84–0.91) |
| Written orders to forgo life-sustaining treatment | ||||
| Do not resuscitate | 131 235 (46.7) | 6102 (30.8) | 4.6 (4.5–4.7) | 0.65 (0.62–0.67) |
| Orders to forgo artificial hydration and nutrition | 16 276 (5.8) | 590 (3.0) | 3.6 (3.3–3.9) | 0.73 (0.67–0.80) |
| Cognitive Performance Score status | ||||
| 4 | 122 161 (43.5) | 7987 (40.2) | 6.5 (6.3–6.7) | 1 [Reference] |
| 5 | 94 605 (33.7) | 4922 (24.8) | 5.2 (5.1–5.3) | 0.96 (0.92–0.99) |
| 6 | 64 103 (22.8) | 6938 (35.0) | 10.8 (10.6–11.1) | 1.57 (1.51–1.64) |
| ADL score indicating severe impairmentb | 51 503 (18.3) | 5905 (29.8) | 11.5 (11.1–11.7) | 1.43 (1.37–1.50) |
Abbreviations: ADL, activities of daily living; AOR, adjusted odds ratio; CI, confidence interval; COPD, chronic obstructive pulmonary disease.
a
Data from the Dartmouth Atlas of Health Care were available for 2679 of 2797 hospitals, resulting in 5459 missing hospital admissions. The model adjusted for hospital characteristics listed in Table 2 as well year of admission, the number of days between the 1999–2007 Nursing Home Minimum Data Set assessment and hospital admission, and number of previous hospital admissions.
b
See “Methods” section for definitions.