Does Percutaneous Gastrostomy Tubes Prevent Or Heal Decubitus Ulcers In Advanced Cognitive Impairment? (310-B)

Abstract

1.Examine the existing evidence regarding the current use of PEG Feeding tubes in health outcomes of persons with advanced dementia.2.Recognize the implications of the current research study that finds that the use of PEG feeding tubes was not associated with prevention or improved healing of decubitus ulcers. Nearly ¾ of physician list decubitus ulcers (DU) as an indication for the use of feeding tube despite a 2009 Cochrane review finding inconclusive evidence to support this indication. Using national data, our goal was to examine whether percutaneous gastrostomy (PEG) tubes prevent or help heal DU in hospitalized nursing home residents (NH) with advanced cognitive impairment and recent onset of the need for eating assistance as indicated by new conversion from Cognitive Performance Score (CPS) to 6. A nearest neighbor propensity match control study was conducted by selecting 3 controls for each case (2,395 NH residents who had a feeding tube inserted during an hospitalization). Based on the Minimum Data Set, we examined two outcomes: (a) Whether a patient without a DU developed a Stage II and higher DU and (b) Whether NH residents with a DU stage II and higher DU had improvement of the DU by the next MDS assessment. Successful propensity matching is evident by a similar socio-demographic characteristic (eg, 28.9% black among those with PEG tubes compared to 29.7% among controls, similar rate of risk factors for feeding tube, and outcomes (ie, 58.1% vs. 58.9% 1-year mortality). Persons who got a PEG tube were 2.18 times more likely to develop a new DU (95% CI 1.9-2.5). Those with a DU were less likely to heal that ulcer when they had a PEG (OR 0.74; 95% CI 0.57-0.97). PEG FTs are not associated with prevention or improved healing of a DU. Rather, our findings suggests that PEG FTs harm NH residents with advanced cognitive impairment.