{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:31:20Z","timestamp":1753878680398,"version":"3.41.2"},"reference-count":64,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T00:00:00Z","timestamp":1722816000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["GSD\u2010164141"],"award-info":[{"award-number":["GSD\u2010164141"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Older People Nursing"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Comfort\u2010focused nutrition orders are recommended to manage eating changes among long\u2010term care (LTC) residents nearing the end of life, though little is known about their current use. This investigation aims to describe current practices and identify resident\u2010level and time\u2010dependent factors associated with comfort\u2010focused nutrition orders in this context.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were retrospectively extracted from resident charts of decedents (\u226565\u2009years at death, admitted \u22656\u2009months) in 18 LTC homes from two sampling frames across southern Ontario, Canada. Observations occurred at 6\u2009months (baseline), 3\u2009months, 1\u2009month and 2\u2009weeks prior to death. Extracted data included functional measures (e.g. cognitive performance, health instability) at baseline, formalised restorative and comfort\u2010focused nutrition care interventions at each timepoint and eating changes reported in the progress notes in 2\u2009weeks following each timepoint. Logistic regression and time\u2010varying logistic regression models determined resident\u2010level (e.g. functional characteristics) and time\u2010dependent factors (e.g. eating changes) associated with receiving a comfort\u2010focused nutrition order.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Less than one\u2010third (30.5%; <jats:italic>n<\/jats:italic>\u2009=\u200950) of 164 participants (61.0% female; mean age\u2009=\u200988.3\u2009\u00b1\u20097.5\u2009years) received a comfort\u2010focused nutrition order, whereas most (99%) received at least one restorative nutrition intervention to support oral food intake. Discontinuation of nutrition interventions was rare (8.5%). Comfort orders were more likely with health instability (OR [95% CI]\u2009=\u20094.35 [1.49, 13.76]), within 2\u2009weeks of death (OR\u2009=\u20095.50 [1.70, 17.11]), when an end\u2010of\u2010life conversation had occurred since the previous timepoint (OR\u2009=\u20095.66 [2.83, 11.33]), with discontinued nutrition interventions (OR\u2009=\u20096.31 [1.75, 22.72]), with co\u2010occurrence of other care plan modifications (OR\u2009=\u20091.48 [1.10, 1.98]) and with a greater number of eating changes (OR\u2009=\u20091.19 [1.02, 1.38]), especially dysphagia (OR\u2009=\u20092.59 [1.09, 6.17]), at the preceding timepoint.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Comfort\u2010focused nutrition orders were initiated for less than one\u2010third of decedents and most often in the end stages of life, possibly representing missed opportunities to support the quality of life for this vulnerable population. An increase in eating changes, including new dysphagia, may signal a need for proactive end\u2010of\u2010life conversations involving comfort nutrition care options.<\/jats:p><\/jats:sec><jats:sec><jats:title>Implications for Practice<\/jats:title><jats:p>Early and open conversations with residents and family about potential eating changes and comfort\u2010focused nutrition care options should be encouraged and planned for among geriatric nursing teams working in LTC. These conversations may be beneficial even as early as resident admission to the home.<\/jats:p><\/jats:sec>","DOI":"10.1111\/opn.12634","type":"journal-article","created":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T08:55:43Z","timestamp":1722848143000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Factors Associated With the Initiation of Comfort\u2010Focused Nutrition Care Orders for Long\u2010Term Care Residents at End of Life"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8929-0427","authenticated-orcid":false,"given":"Jill","family":"Koechl","sequence":"first","affiliation":[{"name":"Department of Kinesiology and Health Sciences University of Waterloo  Waterloo Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Department of Gerontology St. Thomas University  Fredericton New Brunswick Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Heckman","sequence":"additional","affiliation":[{"name":"Schlegel\u2010UW Research Institute for Aging  Waterloo Ontario Canada"},{"name":"School of Public Health Sciences University of Waterloo  Waterloo Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather","family":"Keller","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Health Sciences University of Waterloo  Waterloo Ontario Canada"},{"name":"Schlegel\u2010UW Research Institute for Aging  Waterloo Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,8,5]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1070\u20103241(00)26009\u20104"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12924"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afab108"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010020\u201001931\u2010y"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaging.2015.02.005"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.3138\/jcs.50.2.396"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.14654"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/hsc.13404"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.3928\/00989134\u201020220405\u201001"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010016\u20100256\u20108"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/29.2.165"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/opn.12045"},{"key":"e_1_2_12_14_1","unstructured":"Canadian Hospice Palliative Care Association [CHPCA].2013.\u201cA Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice.\u201d. 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