Decision‐making regarding oral nutritional supplements for nursing home residents with advanced dementia: A cross‐sectional pilot study

Abstract

Background Surrogate decision‐making regarding oral nutritional supplements (ONS) for nursing home residents with advanced dementia is a complex process. In this cross‐sectional study, we assessed whether Dutch dietitians, elderly care physicians (physicians) and surrogate decision‐makers (SDMs) differ in the factors that they regard important when considering ONS. We also investigated differences in opinion regarding whether or not ONS is a life‐prolonging measure. Methods Through an online survey, 90 dietitians, 53 physicians and 70 SDMs of nursing home residents (all aged ≥ 65 years old with advanced dementia) rated the level of perceived influence of 11 pre‐defined factors on their decision‐making, ranked factors in order of importance and stated whether they considered ONS a life‐prolonging measure or not. By statistical analysis, we tested differences in the mean sum of ranks for perceived influence differing between groups. We also tested differences in proportions between groups of those who considered ONS a life‐prolonging measure. Results Rating of perceived influence significantly differed for six factors. Quality of life was ranked as the most influential factor by all groups. Dietitians significantly differed in their opinion on the life‐prolonging effect of ONS from physicians (odds ratio = 0.29, 95% confidence interval = 0.13–0.65), as well as from SDMs (odds ratio = 0.22, 95% confidence interval = 0.10–0.45). Conclusions Although all groups proclaimed quality of life to be first priority in decision‐making, we found that Dutch dietitians, physicians and SDMs differed in what they regarded important when considering ONS for nursing home residents with advanced dementia. Regarding the life‐prolonging effect of ONS, dietitians differed in opinion from physicians, as well as from SDMs.

Exploring complexities in nutritional support across the continuum of care

“…These have been captured in the results of a study from the Netherlands showing a disparity in opinions between dietitians, physicians and surrogate decision makers with respect to therapeutic aims for treating malnutrition in people with dementia. 8 Controversy was demonstrated between professionals' opinions regarding oral nutritional supplements as life prolonging treatment or as a supportive intervention to improve quality of life. 8 Service delivery and clinical outcomes are only one side of the research evaluating nutritional support interventions because listening to patients' experiences has highlighted nuances in nutritional support management, as demonstrated eloquently with qualitative research techniques undertaken with patients, caregivers and healthcare professionals.…”

Malnutrition during the journey of ageing

“…Furthermore, it is unknown if effects of ONS will last a long time as the compliance usually declines over time and the different flavours/textures of ONS do not fulfil the older adults' needs and wishes [277,278]. Next to this, the decision on ONS for nursing home residents with dementia is a complex and ethical process [279]. Possibilities to increase the protein intake should take all nutritional solutions into account, whereby ONS is only one of them and a second choice [279].…”

“…Next to this, the decision on ONS for nursing home residents with dementia is a complex and ethical process [279]. Possibilities to increase the protein intake should take all nutritional solutions into account, whereby ONS is only one of them and a second choice [279].…”

“…The use of oral nutrition support is, in the short term, effective in increasing energy/protein intake [337] but fits not well in experienced-oriented care, is expensive [338] and does not increase life expectancy [275]. Different views on oral nutrition support between doctors, family members of residents, and dietitians make decision-making hard [279]. As family members play an important role in these decisions, but often lack knowledge on food and malnutrition, they have to be informed about the expected positive and negative sides of oral nutrition support.…”