Outcomes of feeding problems in advanced dementia in a nursing home population

Abstract

Objectives: To describe quality of care for feeding problems in advanced dementia and probability and predictors of weight loss and mortality.

Design: Prospective cohort.

Setting: Twenty-four nursing homes (NHs).

Participants: Nursing home residents with advanced dementia and feeding problems and family surrogates (N = 256).

Measurements: Family reported on quality of feeding care at enrollment and 3 months. Chart reviews at enrollment and 3, 6, and 9 months provided data on feeding problems, treatments, weight loss of more than 5% in 30 days or more than 10% in 6 months, and mortality. Organizational variables were obtained from administrator surveys and publically reported data.

Results: Residents with advanced dementia and feeding problems had an average age of 85; 80% had chewing and swallowing problems, 11% weight loss, and 48% poor intake. Family reported feeding assistance of moderate quality; 23% felt the resident received less assistance than needed. Mortality risk was significant; 8% died within 3 months, 17% within 6 months, and 27% within 9 months. Residents with advanced dementia who had stable weight over 3 months had a 5.4% rate of significant weight loss and a 2.1% risk of death over the next 3 months. Residents with advanced dementia and weight loss over 3 months had a 38.9% chance of stabilizing weight over the next 3 months but also had a 19.2% chance of dying. Weight loss was the only independent predictor of death.

Conclusion: Weight loss is a predictor of death in advanced dementia. Treatments can often stabilize weight, but weight loss should be used to trigger discussion of goals of care and treatment options.

Trial registration: ClinicalTrials.gov NCT01113749.

Keywords: dementia; nursing home; nutrition.

Figure 1

Three Month Outcome Probabilities for Advanced Dementia with Feeding Problems A resident with advanced dementia and stable weight has a 5.4% chance of developing weight loss over the next 3 months, and a 2.1% chance of dying during that time interval. A resident with advanced dementia and weight loss has a 38.9% chance of stabilizing weight over the next 3 months, and a 19.2% chance of dying during that same time interval.

Figure 2

Survival Probability for Advanced Dementia with or without Weight Loss P<0.001 for comparison of survival probabilities for weight stable vs. weight loss