Does artificial enteral nutrition prolong the survival of institutionalized elders with chewing and swallowing problems?
Does artificial enteral nutrition prolong the survival of institutionalized elders with chewing and swallowing problems?
复制标题
人工肠内营养能否延长有咀嚼和吞咽问题的住院老年人的生存期？
DOI：
10.1093/gerona/53a.3.m207
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
Lipsitz,LA
中科院分区：
文献类型：
--
作者：
Mitchell,SL;Kiely,DK;Lipsitz,LA
背景有一个关于机构老年人管饲的预后数据缺乏。本研究的目的是确定营养管对有咀嚼和吞咽问题的养老院居民生存的影响，并跟踪管饲居民一年以上的病程。我们使用1991年的最小数据集居民评估进行了一项队列研究，随访12个月。参与者包括居住在华盛顿272家州立疗养院的5，266名65岁以上患有咀嚼和吞咽问题的疗养院居民。有喂食管的居民被确认。比较了有和没有饲管的居民的基线临床特征和12个月生存率。在随访期间，确定管饲居民中无管饲的比例，并检查预测这种结果的临床特征。在有咀嚼和吞咽问题的居民中，10.5%有喂食管。在调整潜在的混杂协变量后，管饲居民的一年死亡率显著高于无管饲居民（风险比，1.44; 95%CI，1.17-1.76）。在430名有饲管的居民中，25.1%的人在随访期内没有饲管。年龄小于87岁与无输卵管的可能性显著增加相关（比值比，1.66; 95%CI，1.03-2.6）。被选中放置饲管的居民一年后的生存率比未接受饲管的居民更差。然而，在存活一年的居民中，很大一部分人的饲管被移除。需要确定具有潜在可逆条件的居民，对他们来说，喂食管是临时干预措施。
Background. There is a lack of prognostic data regarding tube feeding of institutionalized elderly people. The objective of this study was to determine the impact of feeding tubes on the survival of nursing home residents with chewing and swallowing problems, and to follow the course of the tube-fed residents over one year.Methods. We conducted a cohort study with 12-month follow-up using Minimum Data Set resident assessments from 1991. Participants included 5,266 nursing home residents over the age of 65 with chewing and swallowing problems living in 272 Washington state nursing homes. Residents who had a feeding tube were identified. Baseline clinical characteristics and 12-month survival were compared for residents with and without feeding tubes. The proportion of tube-fed residents who became tube-free during the follow-up period was determined, and clinical features that predicted this outcome were examined.Results. Among the residents with chewing and swallowing problems, 10.5% had a feeding tube. After adjusting for potential confounding covariates, tube-fed residents had a significantly higher one-year mortality rate than those without feeding tubes (risk ratio, 1.44; 95% CI, 1.17–1.76). Of the 430 residents with feeding tubes who survived the follow- up period, 25.1% became free of a feeding tube. Age less than 87 years was associated with a significantly greater likelihood of becoming tube-free (odds ratio, 1.66; 95% CI, 1.03–2.6).Conclusions. Residents selected for feeding tube placement have poorer survival after one year than residents who are not tube-fed. However, the feeding tubes are removed in a significant proportion of residents who survive one year. Residents with a potentially reversible condition, for whom the feeding tubes are a temporary intervention, need to be identified.