Indications and practice for tube feeding in Japanese geriatricians: Implications of multidisciplinary team approach

Abstract

The results show that approximately half of the geriatricians prescribe tube feeding when the patient has dementia with loss of appetite or apraxia for eating. There is no consensus among Japanese geriatricians about the indication of tube feeding for demented people. We suggest that guidelines for tube feeding in the elderly should be established. Furthermore, a multidisciplinary approach would be desirable for decision making for tube feeding.

Decreasing Use of Percutaneous Endoscopic Gastrostomy Tube Feeding in Japan

“…After exclusion of those with a mismatched target population and overlapping studies, 4 studies were ultimately included in this review: a cross‐sectional study using a questionnaire to ask geriatricians about indications for PEG tubes and 3 studies that examined the decision‐making process for PEG placement (Table ) . One study reported that more than 90% of geriatricians viewed neurological disorder and stroke as indications for tube feeding and that only 46.8% viewed dementia as an indication . A second study identified 5 factors, including legal or emotional factors, that influence Japanese physicians' decisions to provide artificial nutrition and hydration through a PEG tube .…”

“…Most Japanese physicians recognize that not only neurological disorders, but also advanced dementia are indications for PEG tube placement. 5 In a summary of the main reasons for hesitating to withhold tube feeding, 6 one of the factors affecting the decision was that the universal health insurance system covers PEG tube placement and maintenance, meaning that all people who have lost their oral intake ability can undergo PEG tube placement and receive nutrition through a feeding tube, which reduces the burden on the facility's staff. In addition to the utility of PEG placement as a source of revenue and as a way to reduce labor costs, there is a tendency in Japan to feel that, if a tube is not inserted, the individual will starve to death.…”

Knowledge and Tube Feeding Practices for Older Adult Patients among Japanese Registered Nurses

“…The decision making by nurses on tube feeding, including PEG, does not seem to be related to their clinical experiences or experiences in their workplace. We previously showed that "improvement of general condition and prevention of complications" was a relevant priority for initiating tube feeding by Japanese geriatricians [13]. Therefore, the reason for initiating tube feeding in older patients is different between doctors and nurses.…”

“…According to our previous study, over 90% of geriatricians answered that "neurological disorder" and "stroke" are indications for tube feeding, including PEG, whereas approximately 50% of them answered that "dementia" is an indication for tube feeding [13]. Moreover, geriatricians who organized a multidisciplinary team tended to perform more interventions and care for dysphagia compared with the group that had "no or a few multidisciplinary teams" [13]. Thus, it is important to clarify the thoughts of nurses for tube feeding as healthcare providers and team members of a multidisciplinary team, because nurses have a different role and educational background.…”

“…Este fator pode prender-se com a retirada do paciente da interação social às horas das refeições ou atenção especial que recebem durante a alimentação oral assistida (12,13,17) .…”

<br /><br /> ALIMENTAÇÃO ENTÉRICA NA PESSOA COM DEMÊNCIA: Efeitos, indicações e benefícios<br /> ENTERAL NUTRITION IN PERSON WITH DEMENTIA: Indication, effects and benefits

“…Este fator pode prender-se com a retirada do paciente da interação social às horas das refeições ou atenção especial que recebem durante a alimentação oral assistida (12,13,17) .…”