• Laura C Hanson, Mary Ersek, Feng Chang Lin, and Timothy S Carey.
• Division of Geriatric Medicine, University of North Carolina, Chapel Hill, North Carolina; Center for Aging and Health, University of North Carolina, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina.
• J Am Geriatr Soc. 2013 Oct 1;61(10):1692-7.

ObjectivesTo describe quality of care for feeding problems in advanced dementia and probability and predictors of weight loss and mortality.DesignProspective cohort.SettingTwenty-four nursing homes (NHs).ParticipantsNursing home residents with advanced dementia and feeding problems and family surrogates (N = 256).MeasurementsFamily reported on quality of feeding care at enrollment and 3 months. Chart reviews at enrollment and 3, 6, and 9 months provided data on feeding problems, treatments, weight loss of more than 5% in 30 days or more than 10% in 6 months, and mortality. Organizational variables were obtained from administrator surveys and publically reported data.ResultsResidents with advanced dementia and feeding problems had an average age of 85; 80% had chewing and swallowing problems, 11% weight loss, and 48% poor intake. Family reported feeding assistance of moderate quality; 23% felt the resident received less assistance than needed. Mortality risk was significant; 8% died within 3 months, 17% within 6 months, and 27% within 9 months. Residents with advanced dementia who had stable weight over 3 months had a 5.4% rate of significant weight loss and a 2.1% risk of death over the next 3 months. Residents with advanced dementia and weight loss over 3 months had a 38.9% chance of stabilizing weight over the next 3 months but also had a 19.2% chance of dying. Weight loss was the only independent predictor of death.ConclusionWeight loss is a predictor of death in advanced dementia. Treatments can often stabilize weight, but weight loss should be used to trigger discussion of goals of care and treatment options.© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

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