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Artificial Nutrition Preferences Among California Nursing Home Residents
Lee A Jennings1, Li-Jung Liang2, Neil S Wenger2
1Reynolds Section of Geriatrics and Palliative Medicine, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Journal of the American Geriatrics Society
|May 19, 2025
Summary
Racial disparities in feeding tube use persist among California nursing home residents with dementia. Preferences for artificial nutrition vary significantly by race and ethnicity, indicating potential end-of-life care inequities.
Area of Science:
- Gerontology
- Health Services Research
- Health Equity
Background:
- Feeding tube use offers no proven benefit for advanced dementia patients.
- Despite a decline in feeding tube use, racial disparities persist.
- Understanding these disparities in artificial nutrition is crucial for nursing home residents.
Purpose of the Study:
- To examine artificial nutrition preferences over six years in California nursing home residents.
- To identify racial and ethnic differences in feeding tube use.
- To analyze disparities based on cognition and length of stay.
Main Methods:
- Utilized California nursing home Minimum Data Set (MDS) and Physician Orders for Life Sustaining Treatment (POLST) data (2011-2016).
- Conducted a cross-sectional analysis of artificial nutrition preferences.
- Employed logistic mixed-effects regression, adjusting for resident and facility characteristics.
Main Results:
- Artificial nutrition preferences remained stable over the study period.
- Preference for artificial nutrition increased with cognitive impairment and presence of CPR orders.
- Significant racial and ethnic variations in artificial nutrition preferences were observed, particularly in severely cognitively impaired residents with DNR orders.
Conclusions:
- Persistent racial and ethnic disparities in Physician Orders for Life Sustaining Treatment (POLST) for feeding tube use exist in nursing home residents with dementia.
- These disparities may reflect inequities in end-of-life care quality.
- Further investigation into care quality differences is warranted.
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