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. 2024 Mar;72(3):778-790.
doi: 10.1111/jgs.18729. Epub 2023 Dec 29.

Pre-hospitalization dysphagia and feeding tube placement in nursing home residents with advanced dementia

Raele Donetha Robison  1   2 , Sweta Patel  3 , Jennifer Bunker  3 , James L Rudolph  4   5   6   7 , Joan M Teno  3 , Nicole Rogus-Pulia  1   2   7
Affiliations

Pre-hospitalization dysphagia and feeding tube placement in nursing home residents with advanced dementia

Raele Donetha Robison et al. J Am Geriatr Soc. 2024 Mar.

Abstract

Background: Despite 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.

Methods: A 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.

Results: Between 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).

Conclusions: Based 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.

Keywords: Alzheimer's disease; dysphagia; enteral nutrition; swallowing.

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Conflict of interest statement

Conflicts of Interest: The authors declare they have no conflicts of interest.

Figures

Figure 1:
Figure 1:
Flow diagram for construction of retrospective cohort.
See this image and copyright information in PMC

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References

    1. 2023 Alzheimer’s disease facts and figures. Alzheimers Dement 2023;19(4):1598–1695. doi: 10.1002/alz.13016 - DOI - PubMed
    1. Mitchell SL, Teno JM, Kiely DK, et al. The clinical course of advanced dementia. N Engl J Med 2009;361(16):1529–1538. doi: 10.1056/NEJMoa0902234 - DOI - PMC - PubMed
    1. Rogus-Pulia NM, Plowman EK. Shifting Tides Toward a Proactive Patient-Centered Approach in Dysphagia Management of Neurodegenerative Disease. Am J speech-language Pathol 2020;29(2S):1094–1109. doi: 10.1044/2020_AJSLP-19-00136 - DOI - PMC - PubMed
    1. Humbert IA, McLaren DG, Kosmatka K, et al. Early deficits in cortical control of swallowing in Alzheimer’s disease. J Alzheimers Dis 2010;19(4):1185–1197. doi: 10.3233/JAD-2010-1316 - DOI - PMC - PubMed
    1. Mira A, Gonçalves R, Rodrigues IT. Dysphagia in Alzheimer’s disease: a systematic review. Dement Neuropsychol 2022;16(3):261–269. doi: 10.1590/1980-5764-DN-2021-0073 - DOI - PMC - PubMed

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