Outcomes of Feeding Problems in Advanced Dementia in a Nursing Home Population

ObjectivesTo describe quality of care for feeding problems in advanced dementia and probability and predictors of weight loss and mortality. DesignProspective cohort. SettingTwenty-four nursing homes (NHs). ParticipantsNursing home residents with advanced dementia and feeding problems and family surrogates (N=256). MeasurementsFamily reported on quality of feeding care at enrollment and 3months. Chart reviews at enrollment and 3, 6, and 9months provided data on feeding problems, treatments, weight loss of more than 5% in 30days or more than 10% in 6months, and mortality. Organizational variables were obtained from administrator surveys and publically reported data. ResultsResidents 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 3months, 17% within 6months, and 27% within 9months. Residents with advanced dementia who had stable weight over 3months had a 5.4% rate of significant weight loss and a 2.1% risk of death over the next 3months. Residents with advanced dementia and weight loss over 3months had a 38.9% chance of stabilizing weight over the next 3months but also had a 19.2% chance of dying. Weight loss was the only independent predictor of death. ConclusionWeight 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.