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Nursing home characteristics associated with tube feeding in advanced cognitive impairment
Mitchell SL, Kiely DK, Gillick MR.. Journal of the American Geriatrics Society, 2003-01-01
Topic: Risk, prevention and care in population studies
Objectives To identify nursing homes factors associated with the use of tube feeding in advanced cognitive impairment. Design Descriptive study. Setting The On-line Survey Certification of Automated Records (OSCAR) was used to obtain facility characteristics from 1,057 licensed nursing homes in six states from 1995 to 1996. Participants Residents aged 65 and older with advanced cognitive impairment who had a feeding tube placed over a 1-year period were identified using the Minimum Data Set. Measurements Nursing home characteristics independently associated with feeding tube placement were determined. Results Having a full-time speech therapist on staff, more licensed nurses and fewer nursing assistants were independently associated with greater use of tube feeding in severely cognitively impaired residents. Other features associated with tube feeding included larger facility size, higher proportion of Medicaid beds, absence of an Alzheimer's disease unit, pressure ulcers in 10% or more of residents, and a higher proportion of residents lacking advance directives and with total functional dependency. Conclusions Assessment by a speech therapist, staffing ratios, advance directives, fiscal considerations, and specialized dementia units are potentially modifiable factors in nursing homes that may influence the practice of tube feeding in advanced cognitive impairment.
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APA 7th
Mitchell, S. L., Kiely, D. K., & Gillick, M. R. (2003). Nursing home characteristics associated with tube feeding in advanced cognitive impairment. Journal of the American Geriatrics Society. https://doi.org/10.1034/j.1601-5215.2002.51021.x
Vancouver
Mitchell SL, Kiely DK, Gillick MR. Nursing home characteristics associated with tube feeding in advanced cognitive impairment. Journal of the American Geriatrics Society. 2003. doi:10.1034/j.1601-5215.2002.51021.x. PMID: 12534849.
BibTeX
@article{mitchell2003-12534849,
author = {Mitchell, S. L. and Kiely, D. K. and Gillick, M. R.},
title = {{Nursing home characteristics associated with tube feeding in advanced cognitive impairment}},
journal = {Journal of the American Geriatrics Society},
year = {2003},
doi = {10.1034/j.1601-5215.2002.51021.x},
pmid = {12534849},
url = {https://doi.org/10.1034/j.1601-5215.2002.51021.x}
}
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Key findings
- Objectives To identify nursing homes factors associated with the use of tube feeding in advanced cognitive impairment.
- Measurements Nursing home characteristics independently associated with feeding tube placement were determined.
- Results Having a full-time speech therapist on staff, more licensed nurses and fewer nursing assistants were independently associated with greater use of tube feeding in severely cognitively impaired residents.
- Other features associated with tube feeding included larger facility size, higher proportion of Medicaid beds, absence of an Alzheimer's disease unit, pressure ulcers in 10% or more of residents, and a higher proportion of residents lacking advance directives and with total functional dependency.
Why it matters
This descriptive study of 1,057 nursing homes found that having a full-time speech therapist, more licensed nurses and fewer nursing assistants were independently associated with greater use of tube feeding in severely cognitively impaired residents. It concerns care practices in advanced cognitive impairment and does not test any treatment, cure or prevention for Alzheimer's disease.
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Study details
- Evidence strengthLow
How this study scored 37/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on institution's track record, so that was left out: it earned 36 of the 97 points we could judge it on, which is 37 out of 100.
| 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 | 2003 — older than 20 years, still counted |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 4 / 7 | Cited 67 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 2.7 citations a year over 25 year(s) since 2003 |
| Impact for its field and year | 3 / 6 | Cited 6.6× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 0 / 4 | Cited 2 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Susan L. Mitchell: h-index 70 (OpenAlex, whole career) |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 0 institution(s) in 0 countries — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 12534849) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 36 / 97 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 36 of the 97 points we could judge it on is 37 out of 100. |
| Total | 37 / 100 | — |
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