Artificial Nutrition Preferences Among California Nursing Home Residents

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2025-05-19 DOI:10.1111/jgs.19536

Lee A. Jennings, Li-Jung Liang, Neil S. Wenger, David Powell, Punam Parikh, Jose J. Escarce, David Zingmond

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Abstract

Background

The use of feeding tubes has shown no benefit in persons with advanced dementia and has declined over the last decade in this population. However, racial disparities in feeding tube placement have persisted. To better understand disparities in feeding tube use among nursing home residents, we examined artificial nutrition preferences over 6 years among all California nursing home residents, including differences by race, ethnicity, and cognition.

Methods

We used the CMS Long-term Care Minimum Data Set (MDS) and the California MDS Section S, which reports completion and contents of POLST (Physician Orders for Life Sustaining Treatment) for California nursing home residents, from 2011 to 2016. For each year, we created a cross-sectional cohort and examined racial and ethnic differences in artificial nutrition preferences stratified by resident length of stay, cardiopulmonary resuscitation preference, and degree of cognitive impairment using logistic mixed-effects regression, adjusted for resident and nursing home characteristics.

Results

Of 762,659 unique individuals in California nursing homes from 2011 to 2016, 160,160 completed a POLST in 2011 and 233,868 in 2016. Resident preferences for artificial nutrition did not change substantively over time. Among long-stay residents, the preference for receipt of artificial nutrition was higher among residents with CPR orders, varied by race and ethnicity, and increased as cognitive impairment worsened. This was most pronounced among long-stay residents with severe cognitive impairment and DNR orders, where the preference for receipt of artificial nutrition was lowest among White, non-Hispanic residents (adjusted predicted probability 0.22, 95% 0.21, 0.24) and higher among Black (adjusted difference in probability: +0.22, 95% CI: 0.19–0.26), Hispanic (+0.19, 95% CI: 0.16–0.22), and Asian/Pacific Islander (+0.24, 95% CI: 0.21–0.27) residents.

Conclusions

Racial and ethnic differences in POLST orders for feeding tube use persist among long-term care nursing home residents with dementia and may reflect disparities in end-of-life care quality.

Abstract Image

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加州养老院居民对人工营养的偏好。

背景：在晚期痴呆患者中，饲管的使用没有任何益处，并且在过去十年中有所下降。然而，在喂食管放置方面的种族差异仍然存在。为了更好地了解养老院居民在饲管使用方面的差异，我们对加州所有养老院居民6年来的人工营养偏好进行了调查，包括种族、民族和认知方面的差异。方法：我们使用CMS长期护理最小数据集（MDS）和加利福尼亚州MDS S部分，该部分报告了2011年至2016年加利福尼亚州养老院居民POLST（医师生命维持治疗单）的完成情况和内容。每年，我们创建了一个横断面队列，并使用logistic混合效应回归，根据住院时间、心肺复苏偏好和认知障碍程度进行分层，检查种族和民族在人工营养偏好方面的差异，并根据住院和养老院的特征进行调整。结果：2011年至2016年，在加州养老院的762,659名独特个体中，160,160人在2011年完成了POLST， 2016年完成了233,868人。居民对人工营养的偏好并没有随着时间的推移发生实质性的变化。在长期住院的居民中，接受人工营养的偏好在接受心肺复苏术的居民中更高，因种族和民族而异，随着认知障碍的恶化而增加。这在患有严重认知障碍和DNR命令的长期住院居民中最为明显，其中白人、非西班牙裔居民（调整预测概率0.22,95% 0.21,0.24）对接受人工营养的偏好最低，而黑人居民（调整概率差异：+0.22,95% CI: 0.19-0.26）、西班牙裔居民（+0.19,95% CI: 0.16-0.22）和亚洲/太平洋岛民（+0.24,95% CI: 0.21-0.27）对接受人工营养的偏好较高。结论：老年痴呆患者在POLST饲管使用顺序上存在种族和民族差异，这可能反映了老年痴呆患者临终关怀质量的差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.