Clinical question: How frequently are feeding tubes placed during hospitalization in older adults with dementia, and what patient or regional factors influence their use?
Background: Feeding tube placement in advanced dementia has been discouraged by national guidelines due to lack of demonstrated benefit and potential harm. Nonetheless, there is limited recent data on inpatient placement trends across the U.S.
Study design: Retrospective cohort study using 100% Medicare fee-for-service claims from 2017 to 2023
Setting: National cohort of hospitalized Medicare beneficiaries at least 65 years old with dementia, without prior feeding tube use.
Synopsis: Among more than one million admissions, 2.4% of patients with dementia had a feeding tube placed during hospitalization. Placement was more common in patients with moderate-to-severe dementia, and in those hospitalized for pneumonia, sepsis, or dehydration. There was marked geographic variation in feeding tube use: some hospitals placed tubes in less than 1% of patients, while others exceeded 5%, representing a greater than five-fold difference even after adjustment for patient characteristics. From 2017 to 2023, feeding tube use declined modestly across all regions.
The primary outcome was inpatient initiation of a feeding tube (nasogastric or percutaneous endoscopic gastrostomy). Researchers assessed trends over time and variation by hospital, region, and patient characteristics. Strengths include the large nationally representative cohort and consistent findings across sensitivity analyses. Limitations include reliance on claims data to define dementia severity and lack of insight into patient preferences or clinical decision-making processes.
Bottom line: Despite longstanding recommendations discouraging feeding tube use in dementia, feeding tubes are still placed in roughly one in 40 hospitalizations, with wide variability across institutions. Rates are trending down slowly, but decision making often remains misaligned with palliative goals of care. This study underscores the ongoing need for shared decision making, especially during acute illness in patients with dementia. The significant variation in use across hospitals underscores the influence of local practice patterns. Hospitalists should reflect on whether feeding tube decisions at their institution are driven by patient goals or historical norms—and seek to realign care accordingly. Avoiding default tube placement in favor of comfort-focused care can better reflect patient values and improve outcomes.
Citation: Hartford AM, et al. Use of feeding tubes among hospitalized older adults with dementia. JAMA Netw Open. 2025;8(2):e2460780. doi:10.1001/jamanetworkopen.2024.60780.
Dr. Skandhan is a hospitalist at UT Health San Antonio and a clinical associate professor at the Joe R. & Teresa Long School of Medicine in San Antonio.