Characteristics Associated with Feeding Tube Placement: Retrospective Cohort Study of Texas Nursing Home Residents with Advanced Dementia

Shepard, Victoria; Chou, Lin‐Na; Kuo, Yong Fang; Raji, Mukaila

doi:10.1016/j.jamda.2020.10.033

Cited by 3 publications

(6 citation statements)

References 20 publications

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“…Ten studies examined the use of more intensive and life‐sustaining procedures, such as feeding tubes and mechanical ventilation in PLWD, with all finding higher rates of use of more intensive life‐sustaining procedures in Black American 77–84 PLWD and several studies showing similar results for other minoritized populations 82,85,86 compared to NHW. In terms of specific life‐prolonging procedures, compared to NHW adults, Black Americans had higher rates of feeding tube placement 77,79–84 . One study found higher rates of feeding tube placement in Hispanic Americans compared to NHW 82 .…”

Section: Resultsmentioning

confidence: 99%

“…In terms of specific life‐prolonging procedures, compared to NHW adults, Black Americans had higher rates of feeding tube placement. 77 , 79 , 80 , 81 , 82 , 83 , 84 One study found higher rates of feeding tube placement in Hispanic Americans compared to NHW. 82 Asian Americans were less likely to receive gastrostomy tube placement than NHW 84 ; however, Asian Americans were more likely to receive invasive mechanical ventilation than NHW.…”

Section: Resultsmentioning

confidence: 99%

“…Sixteen studies reported on EOL care for PLWD including on life-prolonging procedures, advanced directives, hospitalizations, and hospice care (see Table 5). Ten studies examined the use of more intensive and life-sustaining procedures, such as feeding tubes and mechanical ventilation in PLWD, with all finding higher rates of use of more intensive life-sustaining procedures in Black American [77][78][79][80][81][82][83][84] PLWD and several studies showing similar results for other minoritized populations 82,85,86 compared to NHW. In terms of specific life-prolonging procedures, compared to NHW adults, Black Americans had higher rates of feeding tube placement.…”

Section: End-of-life Carementioning

confidence: 99%

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Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review

Hinton,

Tran,

Peak

et al. 2024

Alzheimer's & Dementia

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INTRODUCTIONWe set out to map evidence of disparities in Alzheimer's disease and Alzheimer's disease related dementias healthcare, including issues of access, quality, and outcomes for racial/ethnic minoritized persons living with dementia (PLWD) and family caregivers.METHODSWe conducted a scoping review of the literature published from 2000 to 2022 in PubMed, PsycINFO, and CINAHL. The inclusion criteria were: (1) focused on PLWD and/or family caregivers, (2) examined disparities or differences in healthcare, (3) were conducted in the United States, (4) compared two or more racial/ethnic groups, and (5) reported quantitative or qualitative findings.RESULTSKey findings include accumulating evidence that minoritized populations are less likely to receive an accurate and timely diagnosis, be prescribed anti‐dementia medications, and use hospice care, and more likely to have a higher risk of hospitalization and receive more aggressive life‐sustaining treatment at the end‐of‐life.DISCUSSIONFuture studies need to examine underlying processes and develop interventions to reduce disparities while also being more broadly inclusive of diverse populations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: End-of-life Carementioning

confidence: 99%

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Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review

Hinton,

Tran,

Peak

et al. 2024

Alzheimer's & Dementia

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“…Advanced dementia, the final stage of the disease, is characterized by severe memory deficits, feeding difficulties, minimal verbal abilities, inability to ambulate independently or perform any activities of daily living, and urinary and fecal incontinence. The most common symptoms at the end of life are difficulty swallowing, weight loss, aspiration, and breathing difficulties 2 …”

mentioning

confidence: 99%

“…The most common symptoms at the end of life are difficulty swallowing, weight loss, aspiration, and breathing difficulties. 2 Nursing homes (NHs) serve as an important location for providing end-of-life care for patients with advanced dementia. In the United States, more than half of those with dementia died in NHs.…”

mentioning

confidence: 99%

Nursing Home Staff Perceptions of End-of-Life Care for Residents With Advanced Dementia

Akunor

McCarthy

Hendricksen

et al. 2022

J Hosp Palliat Nurs

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Nursing homes (NHs) are an important site of death for residents with advanced dementia. Few studies have explored the experiences of NH staff about providing end-of-life care for residents with advanced dementia. This study aimed to describe NH staff perceptions on where end-of-life care should be delivered, the role of Medicare hospice care, and their experiences providing end-of-life care to residents with advanced dementia. Data from the Assessment of Disparities and Variation for Alzheimer's disease Nursing home Care at End of life study were used to explore the study objectives. Semistructured interviews with 158 NH staff working in 13 NHs across the United States were analyzed. Most NH staff endorsed the NH as a better site of death for residents with advanced dementia compared with a hospital. They expressed mixed perceptions about hospice care. However, regardless of their role, the staff expressed experiencing difficult emotions while providing end-of-life care to residents with dementia because of the close attachments they had formed with them and bearing witness to their decline. The findings show that most NH staff have strong emotional attachments to their dying residents with dementia and prefer to care for them at the NH rather than transfer them to the hospital.

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Annual Wellness Visits and Early Dementia Diagnosis Among Medicare Beneficiaries

Tzeng,

Raji,

Shan

et al. 2024

JAMA Netw Open

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ImportanceEarly recognition of cognitive impairment is key to optimal dementia care. No previous research has examined the probability of developing mild cognitive impairment (MCI) or Alzheimer disease and related dementias (ADRD) at 5-year follow-up among older adult Medicare beneficiaries by receipt of an annual wellness visit (AWV).ObjectiveTo assess the association of incident AWV with the first ADRD or MCI diagnosis among older adults with Medicare fee-for-service benefits.Design, Setting, and ParticipantsThis retrospective population-based cohort study used 100% Texas fee-for-service Medicare data from 2015 to 2022. Participants comprised 549 516 community-dwelling Medicare beneficiaries aged 68 years or older in 2018, with complete Medicare fee-for-service Parts A and B and no Medicare Advantage plan enrollment for 2015 to 2018.ExposureMedicare AWVs.Main Outcomes and MeasuresThe first MCI or ADRD diagnosis (reported as MCI or ADRD diagnosis, MCI diagnosis, and ADRD diagnosis) from the AWV index date in 2018 through December 31, 2022.ResultsIn this cohort study of 549 516 Medicare beneficiaries with no diagnosis of MCI or ADRD in 2015 to 2017 (mean [SD] age, 76.7 [6.6] years; 289 932 women [52.8%]), 66 433 (12.1%) had an incident AWV in 2018. Annual wellness visit recipients were more likely than those who did not receive an AWV to be female, to be non-Hispanic White (followed by Hispanic, non-Hispanic Black, and other), to have more education, to reside in a metropolitan area, to have more comorbidities, and to have a primary care professional in the 12 months before the AWV index date. After propensity score matching, AWV receipt was associated with a 21% increase in MCI diagnosis (hazard ratio, 1.21 [95% CI, 1.16-1.27]) and a 4% increase in ADRD diagnosis (hazard ratio, 1.04 [95% CI, 1.02-1.06]). The increase in MCI diagnosis associated with AWV was larger when the AWV was censored or treated as a time-dependent covariate in the follow-up period.Conclusions and RelevanceThese findings indicate that AWV recipients had a timelier first MCI diagnosis than those who did not receive an AWV, but first ADRD diagnosis differed little. This study suggests that the Medicare AWV health policy may increase MCI identification, prompting more specialized care.

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Characteristics Associated with Feeding Tube Placement: Retrospective Cohort Study of Texas Nursing Home Residents with Advanced Dementia

Cited by 3 publications

References 20 publications

Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review

Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review

Nursing Home Staff Perceptions of End-of-Life Care for Residents With Advanced Dementia

Annual Wellness Visits and Early Dementia Diagnosis Among Medicare Beneficiaries

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