Affiliation:
1. Department of Medicine University of Wisconsin‐Madison School of Medicine and Public Health (SMPH) Madison Wisconsin USA
2. Center for Health Disparities Research University of Wisconsin‐Madison Madison Wisconsin USA
3. School of Public Health Brown University Providence Rhode Island USA
4. Center of Innovation in Long Term Services and Supports (LTSS‐COIN) Providence VA Medical Center Providence Rhode Island USA
5. Warren Alpert Medical School of Brown University Providence Rhode Island USA
6. Center for Gerontology and Healthcare Research Brown University School of Public Health Providence Rhode Island USA
7. Geriatric Research Education and Clinical Center William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
Abstract
AbstractBackgroundDespite 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.MethodsA 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.ResultsBetween 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).ConclusionsBased 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.
Funder
National Institute on Aging
Subject
Geriatrics and Gerontology