Related Experiment Video
Updated: May 20, 2025
Palatable Western-style Cafeteria Diet as a Reliable Method for Modeling Diet-induced Obesity in Rodents
Published on: November 1, 2019
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.
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.
Related Concept Videos
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...
01:29Documentation in Long-Term and Home Healthcare Setting
Long-Term Care Facilities
01:27Ethical Issues
Ethical Concerns in Healthcare:
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:27Nursing Ethical Principles II
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's...