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A cross-national survey of tube-feeding decisions in cognitively impaired older persons
Mitchell SL, Berkowitz RE, Lawson FM, Lipsitz LA.. Journal of the American Geriatrics Society, 2000-04-01
Topic: Risk, prevention and care in population studies
Objectives Many factors affect the decision to institute long-term tube-feeding in older persons. The objectives of this cross-national survey are to examine the tube-feeding decision-making process for cognitively impaired older persons from the perspective of the substitute decision-makers (SDM) and to contrast this process in US and Canadian healthcare settings. Design Survey. Setting Chronic care facilities in Ottawa and nursing homes in Boston. Participants Patients more than age 65 who were tube-fed for at least 2 months and who were unable to make their own healthcare decisions at the time of tube placement were identified at both sites. The SDMs of 46 patients in Ottawa and 48 patients in Boston were surveyed. Measurements The survey asked questions relating to the following categories: health status of the patient, advance directives, communication with the healthcare team, perceived goals of tube-feeding, decision satisfaction, and sociodemographic data. Results Tube-fed patients in Boston were more likely to have a diagnosis of dementia than those in Ottawa (60.4% vs 10.9%, P Conclusions A greater proportion of patients have feedings tubes inserted because of a degenerative dementia in Boston compared with an acute neurological event in Ottawa. Despite the difference in diagnostic indication for tube-feeding, the substitute decision-making process was seriously limited at both sites by poor implementation of the principle of substituted judgement, a need for broader advance directives, and improved transfer of knowledge between clinicians and decision-makers.
Key findings
- Results Tube-fed patients in Boston were more likely to have a diagnosis of dementia than those in Ottawa (60.4% vs 10.9%, P Conclusions A greater proportion of patients have feedings tubes inserted because of a degenerative dementia in Boston compared with an acute neurological event in Ottawa.
Why it matters
This survey compared tube-feeding decisions for cognitively impaired older patients in US and Canadian care settings, finding that more patients in Boston had feeding tubes inserted because of degenerative dementia. It concerns decision-making about feeding tubes, not the treatment, cure, or prevention of Alzheimer's disease.
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Study details
- Participants46
- Effect size60.4%; 10.9%
- Evidence strengthLow
How this study scored 48/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Geriatrics Society) |
| Journal's citation record | 3 / 4 | Journal of the American Geriatrics Society: journal h-index 344 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2000 — older than 20 years, still counted |
| Sample size | 1 / 4 | 46 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 114 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 4.1 citations a year over 28 year(s) since 2000 |
| Impact for its field and year | 4 / 6 | Cited 9.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 2 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Lewis Arnold Lipsitz: h-index 109 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Beth Israel Deaconess Medical Center: institution h-index 1,219 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 10798465) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 48 / 100 | — |
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Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Mitchell, S. L., Berkowitz, R. E., Lawson, F. M., & Lipsitz, L. A. (2000). A cross-national survey of tube-feeding decisions in cognitively impaired older persons. Journal of the American Geriatrics Society. https://doi.org/10.1111/j.1532-5415.2000.tb04696.x
Vancouver
Mitchell SL, Berkowitz RE, Lawson FM, Lipsitz LA. A cross-national survey of tube-feeding decisions in cognitively impaired older persons. Journal of the American Geriatrics Society. 2000. doi:10.1111/j.1532-5415.2000.tb04696.x. PMID: 10798465.
BibTeX
@article{mitchell2000-10798465,
author = {Mitchell, S. L. and Berkowitz, R. E. and Lawson, F. M. and Lipsitz, L. A.},
title = {{A cross-national survey of tube-feeding decisions in cognitively impaired older persons}},
journal = {Journal of the American Geriatrics Society},
year = {2000},
doi = {10.1111/j.1532-5415.2000.tb04696.x},
pmid = {10798465},
url = {https://doi.org/10.1111/j.1532-5415.2000.tb04696.x}
}
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