Nice post over at Geripal
that explores the factors that contribute to demented patients getting feeding tubes prior to discharge from a hospital. One of the more demoralizing aspects of modern practice, for me, is to see these demented lost souls who get admitted to the hospital and are subjected to millions dollar work-ups and undergo needless invasive procedures--- procedures like PEG tubes and tracheostomies that serve merely to prolong life without affecting the quality or meaning of life.
From joint Harvard/Brown University study in this week's JAMA:
In the multivariable analyses, nursing home residents with advanced cognitive impairment were more likely to get a feeding tube if admitted to:
*Hospitals with greater ICU utilization for decedents with chronic illness in the last 6 months of life
*A for-profit hospital vs hospitals owned by state or local government
*Hospitals with a greater number of beds (>310 beds vs <101 beds)
Location, location, location.
I don't understand the racial aspect, though.
Really it's more than just feeding tubes.
These poor folks should not be anywhere near an ICU. They should not be getting thousand dollar workups, they don't belong in my (or anybody's) OR. The trouble really starts when they are transported to a hospital in the first place.
Spectacularly futile "care" is probably the thing we do worst in the US.
I wouldn't do it to my dog. I wouldn't do it to my Mom.
Also, for many families it is impossible to understand how these things can actually be cruel. They really feel that they are helping provide basic comfort. There is such a disconnect, no matter how smooth you are in having "The Talk" with them -- or maybe we shouldn't be so smooth? But that would be a Press-Ganey problem.
Better watch it or you will be acused of running a "Death Pannel"! I plan on retiring in a state that allows you to decide when enough is enough. I have a Living Will and Durable Power of Attorney all filled out.
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