Indications and practice for tube feeding in Japanese geriatricians: Implications of multidisciplinary team approach
The aim of this study was to examine how geriatricians decide the indication of tube feeding in the elderly with eating difficulty as a result of several disorders, and to determine the factors associated with their decision making and interventions for dysphagia.The design was a cross-sectional study. All board-certified geriatricians in the Japan Geriatrics Society were recruited to this study in September 2010. We sent questionnaires to 1469 geriatricians. Among them, 629 agreed to participate. The survey consisted of self-administered questionnaires regarding demographic information, indications of tube feeding and interventions for dysphagia before tube feeding.We analyzed the remaining 555 questionnaires after excluding incomplete ones. Over 90% of geriatricians answered that "neurological disorder" and "stroke" are indications, whereas 46.8% of them answered that "dementia" is an indication for tube feeding. Geriatricians who organize a multidisciplinary team conference tended to carry out more "interventions for dysphagia before the prescription of tube feeding" compared with the reference group (odds ratio 2.1-8.7) after multivariate adjustment.The results show that approximately half of the geriatricians prescribe tube feeding when the patient has dementia with loss of appetite or apraxia for eating. There is no consensus among Japanese geriatricians about the indication of tube feeding for demented people. We suggest that guidelines for tube feeding in the elderly should be established. Furthermore, a multidisciplinary approach would be desirable for decision making for tube feeding.