TY - JOUR
T1 - Enteral feeding in end-stage dementia
T2 - A comparison of religious, ethnic, and national differences in Canada and Israel
AU - Clarfield, A. Mark
AU - Monette, Johanne
AU - Bergman, Howard
AU - Monette, Michele
AU - Ben-Israel, Yehoshua
AU - Caine, Yehezkel
AU - Charles, Jocelyn
AU - Gordon, Michael
AU - Gore, Brian
N1 - Funding Information:
ACKNOWLEDGMENTS In Israel, the study was supported in part by the Israel National Institute for Health Policy and Health Services Research. At the time of the study, Dr. J. Monette was the recipient of a bursary from Le Fonds de la recherche en santé du Québec (FRSQ) as a clinical investigator. In Canada, the project was funded in part through the Division of Geriatric Medicine of the Sir Mortimer B. Davis–Jewish General Hospital, the Dr. Joseph Kaufmann Chair in Geriatric Medicine, and the Maimonides Hospital Geriatric Centre.
PY - 2006/1/1
Y1 - 2006/1/1
N2 - Background. Although enterai feeding in end-stage dementia is thought by many clinicians to he "futile," it is still widely used. We examined rates of tube feeding (gastrostomy or nasogastric) in end-stage dementia in hospitals in both Canada and Israel, and hypothesized that Canadian non-Jewish affiliated hospitals would have the lowest (and Israeli institutions the highest), with Canadian Jewish hospitals exhibiting intermediate rates. Methods. We conducted a cross-sectional survey of six geriatric long-term hospitals: two in Israel and four in Canada (two Jewish affiliated, two not; two in Ontario, two in Quebec province). Patients with end-stage dementia were assessed and further analyzed for type of feeding. Results. In the six hospitals, 2287 long-term beds were surveyed, of which 1358 (59.4%) were used by demented patients of whom 376 (27.7%) were severely demented (Global Deterioration Scale-level 7). Of these, 24.5% (92) were fed by nasogastric tube or gastrostomy tube. Significant differences in tube-feeding prevalence were found between Canada (11%) and Israel (52.9%), with only 4,7% seen in non-Jewish Canadian institutions. Jewish affiliated hospitals in Canada exhibited an intermediate rate of 19.6%. However, for within-country dyads, wide differences were also found. When we examined patient religion, we found that Canadian non-Jewish patients had the lowest rates (3,2%), Israeli Jewish patients the highest (51.7%), and Canadian Jewish patients exhibited an intermediate rate (19.0%) of tube use. Conclusions. Despite reservations concerning its utility, feeding tube use is reasonably widespread in patients who have reached the stage of severe dementia. Canadian institutions exhibited a lower prevalence of feeding tube use than did Israeli hospitals. Between-country and between-province differences in practice may be explained by some combination of administrative and/or financial incentives, religion, and culture; within-country and within-ethnic group differences may be caused, at least in part, by differing institutional cultures.
AB - Background. Although enterai feeding in end-stage dementia is thought by many clinicians to he "futile," it is still widely used. We examined rates of tube feeding (gastrostomy or nasogastric) in end-stage dementia in hospitals in both Canada and Israel, and hypothesized that Canadian non-Jewish affiliated hospitals would have the lowest (and Israeli institutions the highest), with Canadian Jewish hospitals exhibiting intermediate rates. Methods. We conducted a cross-sectional survey of six geriatric long-term hospitals: two in Israel and four in Canada (two Jewish affiliated, two not; two in Ontario, two in Quebec province). Patients with end-stage dementia were assessed and further analyzed for type of feeding. Results. In the six hospitals, 2287 long-term beds were surveyed, of which 1358 (59.4%) were used by demented patients of whom 376 (27.7%) were severely demented (Global Deterioration Scale-level 7). Of these, 24.5% (92) were fed by nasogastric tube or gastrostomy tube. Significant differences in tube-feeding prevalence were found between Canada (11%) and Israel (52.9%), with only 4,7% seen in non-Jewish Canadian institutions. Jewish affiliated hospitals in Canada exhibited an intermediate rate of 19.6%. However, for within-country dyads, wide differences were also found. When we examined patient religion, we found that Canadian non-Jewish patients had the lowest rates (3,2%), Israeli Jewish patients the highest (51.7%), and Canadian Jewish patients exhibited an intermediate rate (19.0%) of tube use. Conclusions. Despite reservations concerning its utility, feeding tube use is reasonably widespread in patients who have reached the stage of severe dementia. Canadian institutions exhibited a lower prevalence of feeding tube use than did Israeli hospitals. Between-country and between-province differences in practice may be explained by some combination of administrative and/or financial incentives, religion, and culture; within-country and within-ethnic group differences may be caused, at least in part, by differing institutional cultures.
UR - http://www.scopus.com/inward/record.url?scp=33745199162&partnerID=8YFLogxK
U2 - 10.1093/gerona/61.6.621
DO - 10.1093/gerona/61.6.621
M3 - Article
C2 - 16799146
AN - SCOPUS:33745199162
SN - 1079-5006
VL - 61
SP - 621
EP - 627
JO - Journals of Gerontology - Series A Biological Sciences and Medical Sciences
JF - Journals of Gerontology - Series A Biological Sciences and Medical Sciences
IS - 6
ER -