Tube Feeding in Advanced Dementia: An Exploratory Survey of Physician Knowledge

2006 ◽  
Vol 7 (2) ◽  
pp. 79-85 ◽  
Author(s):  
Caroline A. Vitale ◽  
Tad Hiner ◽  
Wayne Ury ◽  
Cathy Berkman ◽  
Judith C. Ahronheim
Keyword(s):  
Primary Care Physicians ◽  
Tube Feeding ◽  
Mail Survey ◽  
Current Evidence ◽  
Artificial Nutrition ◽  
Advanced Dementia ◽  
Significant Treatment ◽  
Physician Knowledge ◽  
Endoscopic Gastrostomy ◽  
Peg Tube

The administration of artificial nutrition by means of a percutaneous endoscopic gastrostomy (PEG) tube in older persons in the advanced stages of dementia is commonplace, yet the treatment is associated with significant treatment burdens and unclear benefits in this population. In addition, there is wide and unexplained geographic variability in the use of PEG in advanced dementia, which may stem partly from physicians’ lack of understanding about its indications, risks, benefits, and effect on quality of life in advanced dementia. This study was a mail survey undertaken to assess physician knowledge regarding tube feeding in advanced dementia and explore whether certification in geriatrics or other physician characteristics are associated with physician knowledge. To assess knowledge about tube feeding, we asked participants to rate the importance of commonly cited, but non–evidence based, indications for tube feeding in advanced dementia, including recurrent aspiration pneumonia, abnormal swallowing evaluations, abnormal nutritional parameters, preventing an uncomfortable death, and others. Discrepancies between physician knowledge and current evidence regarding tube feeding in advanced dementia were found, indicating a need for improved education of primary care physicians in order to ultimately provide better end-of-life care for patients with advanced dementia.

scholarly journals Long-Term Survival of Patients Receiving Artificial Nutrition in Japanese Psychiatric Hospitals

2016 ◽  
Vol 6 (3) ◽  
pp. 477-485 ◽  
Author(s):  
Keiichi Abe ◽  
Ryuko Yamashita ◽  
Keiko Kondo ◽  
Keiko Takayama ◽  
Osamu Yokota ◽  
...  
Keyword(s):  
Multiple Logistic Regression Analysis ◽  
Tube Feeding ◽  
Oral Intake ◽  
Psychiatric Hospitals ◽  
Artificial Nutrition ◽  
Term Survival ◽  
Long Term Survival ◽  
Endoscopic Gastrostomy ◽  
Peg Tube

Background/Aims: Most patients with dementia suffer from dysphagia in the terminal stage of the disease. In Japan, most elderly patients with dysphagia receive either tube feeding or total parenteral nutrition. Methods: In this study, we investigated the factors determining longer survival with artificial nutrition. Various clinical characteristics of 168 inpatients receiving artificial nutrition without oral intake in psychiatric hospitals in Okayama Prefecture, Japan, were evaluated. Results: Multiple logistic regression analysis showed that the duration of artificial nutrition was associated with a percutaneous endoscopic gastrostomy (PEG) tube, diagnosis of mental disorder, low MMSE score, and absence of decubitus. Conclusion: Patients with mental disorders survived longer than those with dementia diseases on artificial nutrition. A PEG tube and good nutrition seem to be important for long-term survival.

scholarly journals Racial and Socioeconomic Disparities in Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement among elderly patients with dementia in the United States from the National inpatient sample

2020 ◽  
Author(s):  
Tanureet Kochar ◽  
Ashraf Abugroun ◽  
Asma Nayyar ◽  
Manar Abdel- Rahman ◽  
Pragnesh J Patel
Keyword(s):  
Elderly Patients ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Low Income ◽  
Socioeconomic Disparities ◽  
Tube Placement ◽  
Advanced Dementia ◽  
National Inpatient Sample ◽  
Endoscopic Gastrostomy ◽  
Icd 10 ◽  
Peg Tube

Abstract Background Placement of percutaneous endoscopic gastrostomy (PEG) tube in patients of advanced dementia has not been shown to improve nutritional status or mortality. The objective is to assess racial and socioeconomic disparities for PEG tube placement from National Inpatient Sample. Methods In a cross-sectional study, the National inpatient sample (NIS) registry was queried for all patients aged ≥ 70 who were diagnosed with dementia during the year 2016. Patients with dementia were identified using the Tenth revision (ICD-10) codes (F0150, F0151, F0280, F0281, F0390, F0391, G300, G301, G308, G309, G3109, G3183). Patients who received PEG tube were identified using ICD-10 diagnosis codes (Z431). Multivariable logistic regression models were utilized to determine the likelihood of PEG tube placement with adjustment for Patients demographics, socioeconomic factors, degree of frailty and comorbidities. Results Out of 1,745,028 patients with dementia, 35,075 patients had PEG tube placed. Majority of patients who received PEG tube were females (54.8%), of white race (45.5%) with a mean age of 82.3 years (SEM 0.02). Compared to controls, those who had PEG tube placement were more frail, had higher prevalence of chronic lung disease, diabetes, stroke, psychosis and nutritional deficiency anemias. On multivariable analysis, higher risk for PEG tube placement was seen in African Americans and Hispanics compared to Caucasians with a-OR 3.76 [95%CI: 3.47–4.07], p < 0.001 and 2.59 [95%CI:2.33–2.88], p < 0.001 respectively. A higher risk was also seen in patients with low income with a-OR 1.1(95%CI: 1.04–1.19), p = 0.002 and among those having Medicaid compared to Medicare insurance with a-OR 1.53 [95%CI: 1.30–1.80], p < 0.001. Compared to males, females were found to have low chances for PEG tube placement with a-OR: 0.78 [95%CO:0.74–0.82], p < 0.001. Hospital ownership, bed size and teaching status were found to have no impact on PEG tube utilization. Conclusion Despite the evidence against placement of PEG tubes in dementia patients, our findings confirm that PEG tubes are still being placed in frail and demented elderly. Apart from these, elderly patients with low income, African American origin and Medicaid enrollees have higher incidence of PEG tube placements. Efforts are needed to educate clinicians and community about worse outcomes of PEG tube placement in advanced dementia.

scholarly journals Endoscopic Repair of Gastrocolic and Colocutaneous Fistulas Complicating Percutaneous Endoscopic Gastrostomy Tube

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Chukwunonso Chime ◽  
Ahmed Baiomi ◽  
Kishore Kumar ◽  
Harish Patel ◽  
Anil Dev ◽  
...  
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Tube Feeding ◽  
Care Facility ◽  
Index Patient ◽  
Safe Procedure ◽  
Percutaneous Endoscopic Gastrostomy Tube ◽  
Term Care ◽  
Long Term Care Facility ◽  
Endoscopic Gastrostomy ◽  
Peg Tube

Percutaneous endoscopic gastrostomy (PEG) tube feeding has become one of the options for supplemental feeding in a selected group of patients. It is a generally safe procedure usually undertaken by a gastroenterologist or a surgeon in most cases but with over 200,000 tubes being placed yearly, there is bound to be complications. Some of the encountered complications include bleeding, site infection, tube migration, and inadvertent creation of fistula. We present our index patient admitted from a long-term care facility for feculent vomiting and fecal material through the PEG tube. Imaging and colonoscopy confirmed the presence of both a gastrocolic and a colocutaneous fistula, both closed endoscopically with an over-the-scope and through-the-scope clips, respectively. Feeding through a nasogastric tube was resumed after 48 hours, and by the second week of admission, the patient was discharged back to the facility after placement of a new PEG tube.

Use of percutaneous endoscopic gastrostomy (PEG) tube feeding support in head and neck cancer patients.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. e18062-e18062
Author(s):  
Ramla Namisango Kasozi ◽  
Anita Choudhary ◽  
Kelly Andrus ◽  
Richard C.K. Wong ◽  
Rory Eric Randall ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Neck Cancer ◽  
Tube Feeding ◽  
Endoscopic Gastrostomy ◽  
Peg Tube

Healthcare professionals' attitudes towards PEG tube feeding in advanced dementia: time to engage with a wide clinical audience?

2019 ◽  
Vol 65 (3) ◽  
Author(s):  
Sebastian Adu-Tei ◽  
Hugo A. Penny ◽  
Mansour El-Fekhi ◽  
Charlotte Ruse ◽  
David S. Sanders
Keyword(s):  
Healthcare Professionals ◽  
Tube Feeding ◽  
Advanced Dementia ◽  
Peg Tube

scholarly journals Rectal Bleeding after Insertion of a Percutaneous Endoscopic Gastrostomy Tube

2020 ◽  
Vol 14 (3) ◽  
pp. 637-643
Author(s):  
Ghadeer Alhazmi ◽  
Mroj Alsabri ◽  
Shahad Alsuwat ◽  
Adnan Al-Zangabi ◽  
Abdulaziz Al-Zahrani ◽  
...  
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Rectal Bleeding ◽  
Rare Complication ◽  
Tube Feeding ◽  
Tube Placement ◽  
Percutaneous Endoscopic Gastrostomy Tube ◽  
Colon Injury ◽  
Tube Insertion ◽  
Endoscopic Gastrostomy ◽  
Peg Tube

Iatrogenic injury to an internal organ such as the stomach, colon, small bowel, or liver after percutaneous endoscopic gastrostomy (PEG) tube insertion is a rare complication. We present a case of rectal bleeding due to colon injury during PEG tube placement. This required urgent exploratory laparoscopic surgery with segmental resection of the transverse colon and replacement of the PEG tube. Postoperatively, the patient significantly improved with time and tolerated PEG tube feeding.

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