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
. 2025 Aug;73(8):2441-2446.
doi: 10.1111/jgs.19536. Epub 2025 May 19.

Artificial Nutrition Preferences Among California Nursing Home Residents

Lee A Jennings  1 , Li-Jung Liang  2 , Neil S Wenger  2 , David Powell  3 , Punam Parikh  2 , Jose J Escarce  2 , David Zingmond  2
Affiliations

Artificial Nutrition Preferences Among California Nursing Home Residents

Lee A Jennings et al. J Am Geriatr Soc. 2025 Aug.

Abstract

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.

Keywords: artificial nutrition; dementia; end‐of‐life care; long‐term care; race disparity.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: All of the authors declare that they have no conflicts of interest with regard to this manuscript.

Similar articles

See all similar articles

References

    1. Teno JM, et al. , Decision-making and outcomes of feeding tube insertion: a five-state study. J Am Geriatr Soc, 2011. 59(5): p. 881–6. - PMC - PubMed
    1. Yuen JK, et al. , Reduced Pneumonia Risk in Advanced Dementia Patients on Careful Hand Feeding Compared With Nasogastric Tube Feeding. J Am Med Dir Assoc, 2022. 23(9): p. 1541–1547 e2. - PubMed
    1. Davies N, et al. , Enteral tube feeding for people with severe dementia. Cochrane Database Syst Rev, 2021. 8(8): p. CD013503. - PMC - PubMed
    1. Kuo S, et al. , Natural history of feeding-tube use in nursing home residents with advanced dementia. J Am Med Dir Assoc, 2009. 10(4): p. 264–70. - PMC - PubMed
    1. Medicine A.B.o.I. Choosing Wisely Program. 2013. 12/18/2024]; Available from: https://www.choosingwisely.org/.