Feeding Tubes and the Prevention or Healing of Pressure Ulcers

Background: The evidence regarding the use of feeding tubes in persons with advanced dementia to prevent orhealpressureulcersisconflicting.Usingnationaldata, we set out to determine whether percutaneous endoscopicgastrostomy(PEG)tubespreventorhelphealpressure ulcers in nursing home (NH) residents with advanced cognitive impairment (ACI). Methods: A propensity-matched cohort study of NH residents with ACI and recent need for assistance in eating was conducted by matching each NH resident who had a feeding tube inserted during a hospitalization to 3 without a PEG tube inserted. Using the Minimum Data Set (MDS), we examined 2 outcomes: first, whether residents without a pressure ulcer developed a stage 2 or higher pressure ulcer (n=1124 with PEG insertion); and second, whether NH residents with a pressure ulcer (n=461) experienced improvement of the pressure ulcer by their first posthospitalization MDS assessment (mean [SD] time between evaluations, 24.6 [32.7] days). Results: Matched residents with and without a PEG insertionshowedcomparablesociodemographiccharacteristic, rates of feeding tube risk factors, and mortality. Adjustedforriskfactors,hospitalizedNHresidentsreceiving a PEG tube were 2.27 times more likely to develop a new pressureulcer(95%CI,1.95-2.65).Conversely,thosewith apressureulcerwerelesslikelytohavetheulcerhealwhen theyhadaPEGtubeinserted(OR0.70[95%CI,0.55-0.89]). Conclusions:Feeding tubes are not associated with prevention or improved healing of a pressure ulcer. Rather, our findings suggest that the use of PEG tube is associatedwithincreasedriskofpressureulcersamongNHresidents with ACI.