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Pre‐hospitalization dysphagia and feeding tube placement in nursing home residents with advanced dementia.
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- Author(s): Robison, Raele Donetha; Patel, Sweta; Bunker, Jennifer; Rudolph, James L.; Teno, Joan M.; Rogus‐Pulia, Nicole
- Source:
Journal of the American Geriatrics Society; Mar2024, Vol. 72 Issue 3, p778-790, 13p- Subject Terms:
RISK assessment; THERAPEUTICS; GASTRIC intubation; RESEARCH funding; SECONDARY analysis; ALZHEIMER'S disease; HOSPITAL care; LOGISTIC regression analysis; RETROSPECTIVE studies; DESCRIPTIVE statistics; LONGITUDINAL method; ENTERAL feeding; ODDS ratio; MEDICAL coding; ENDOSCOPIC gastrointestinal surgery; GASTROSTOMY; PAIN; DEGLUTITION; DEMENTIA; CONFIDENCE intervals; DEGLUTITION disorders; FEEDING tubes; DEMENTIA patients; NOSOLOGY; DISEASE risk factors - Source:
- Additional Information
- Subject Terms:
- Abstract: Background: Despite research demonstrating the risks of using feeding tubes in persons with advanced dementia, they continue to be placed. The natural history of dysphagia among patients with advanced dementia has not been examined. We conducted a secondary analysis of a national cohort of persons with advanced dementia staying at a nursing home stay before hospitalization to examine (1) pre‐hospitalization dysphagia prevalence and (2) risk of feeding tube placement during hospitalization based on preexisting dysphagia. Methods: A retrospective cohort study consisting of all nursing home (NH) residents (≥66 years) with advanced dementia (Cognitive Function Scale score ≥2), a hospitalization between 2013–2017, and a Minimum Data Set (MDS) 3.0 assessment within 120 days before hospitalization. Pre‐hospitalization dysphagia status and surgically placed feeding tube insertion during hospitalization were determined by MDS 3.0 swallowing items and ICD‐9 codes, respectively. A multivariate logistic model clustering on hospital was used to examine the association of dysphagia with percutaneous endoscopic gastrostomy (PEG) feeding tube placement after adjustment for confounders. Results: Between 2013 and 2017, 889,983 persons with NH stay with advanced dementia (mean age: 84.5, SD: 7.5, and 63.5% female) were hospitalized. Pre‐hospitalization dysphagia was documented in 5.4% (n = 47,574) and characterized by oral dysphagia (n = 21,438, 2.4%), pharyngeal dysphagia (n = 24,257, 2.7%), and general swallowing complaints/pain (n = 14,928, 1.7%). Overall, PEG feeding tubes were placed in 3529 patients (11.2%) with pre‐hospitalization dysphagia, whereas 27,893 (88.8%) did not have pre‐hospitalization dysphagia according to MDS 3.0 items. Feeding tube placement risk increased with the number of dysphagia items noted on the pre‐hospitalization MDS (6 vs. 0 dysphagia variables: OR = 5.43, 95% CI: 3.19–9.27). Conclusions: Based on MDS 3.0 assessment, only 11% of PEG feeding tubes were inserted in persons with prior dysphagia. Future research is needed on whether this represents inadequate assessment or the impact of potentially reversible intercurrent illness resulting in feeding tube placement. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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