Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2011 Nov;59(11):2009-16.
doi: 10.1111/j.1532-5415.2011.03629.x. Epub 2011 Sep 15.

Improving decision-making for feeding options in advanced dementia: a randomized, controlled trial

Laura C Hanson  1 , Timothy S Carey, Anthony J Caprio, Tae Joon Lee, Mary Ersek, Joanne Garrett, Anne Jackman, Robin Gilliam, Kathryn Wessell, Susan L Mitchell
Affiliations
Randomized Controlled Trial

Improving decision-making for feeding options in advanced dementia: a randomized, controlled trial

Laura C Hanson et al. J Am Geriatr Soc. 2011 Nov.

Abstract

Objectives: To test whether a decision aid improves quality of decision-making about feeding options in advanced dementia.

Design: Cluster randomized controlled trial.

Setting: Twenty-four nursing homes in North Carolina.

Participants: Residents with advanced dementia and feeding problems and their surrogates.

Intervention: Intervention surrogates received an audio or print decision aid on feeding options in advanced dementia. Controls received usual care.

Measurements: Primary outcome was the Decisional Conflict Scale (range: 1-5) measured at 3 months; other main outcomes were surrogate knowledge, frequency of communication with providers, and feeding treatment use.

Results: Two hundred fifty-six residents and surrogate decision-makers were recruited. Residents' average age was 85; 67% were Caucasian, and 79% were women. Surrogates' average age was 59; 67% were Caucasian, and 70% were residents' children. The intervention improved knowledge scores (16.8 vs 15.1, P < .001). After 3 months, intervention surrogates had lower Decisional Conflict Scale scores than controls (1.65 vs 1.90, P < .001) and more often discussed feeding options with a healthcare provider (46% vs 33%, P = .04). Residents in the intervention group were more likely to receive a dysphagia diet (89% vs 76%, P = .04) and showed a trend toward greater staff eating assistance (20% vs 10%, P = .08). Tube feeding was rare in both groups even after 9 months (1 intervention vs 3 control, P = .34).

Conclusion: A decision aid about feeding options in advanced dementia reduced decisional conflict for surrogates and increased their knowledge and communication about feeding options with providers.

Trial registration: ClinicalTrials.gov NCT01113749.

PubMed Disclaimer

Figures

Figure
Figure
Improving Decision-Making Recruitment and Retention
See this image and copyright information in PMC

References

    1. Hebert LI, Scherr PA, Bienias JL, et al. Alzheimer’s disease in the US population: Prevalence estimates using the 2000 census. Arch Neurol. 2003;60:1119–1122. - PubMed
    1. Larson EB, Shadlen MF, Wang L, et al. Survival after initial diagnosis of Alzheimer disease. Ann Intern Med. 2004;140:501–509. - PubMed
    1. Boustani M, Peterson CB, Hanson LC, et al. Screening for dementia syndrome: A review of the evidence. Ann Intern Med. 2003;138:927–937. - PubMed
    1. Reisberg B, Ferris SH, De Leon MJ, et al. The global deterioration scale for assessment of primary degenerative dementia. Am J Psychiatry. 1982;139:1136–1139. - PubMed
    1. Mitchell SL, Teno JM, Kiely DK, et al. The clinical course of advanced dementia. N Engl J Med. 2009;361:1529–1538. - PMC - PubMed

Publication types

Associated data