Outcomes of Percutaneous Endoscopic Gastrostomy in Dementia Patients

Lindemann, B.; Nikolaus, Th.

doi:10.1046/j.1532-5415.2001.49170.x

Cited by 7 publications

(5 citation statements)

References 4 publications

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“…In a study of 36 severely cognitively compromised adults (mean age = 83), the principal indications for PEG tube placement were persistent: oral intake decline (53 percent), reduced oral intake after acute medical complications (31 percent), disruptive dysphagia (11 percent), and behavior disturbances (5 percent). 28 PEG mortality and morbidity rates PEG tube placement is not innocuous; it has varied mortality and morbidity rates, often depending on the population.1'29 PEG complication rates have been reported to range from 17 to 32 percent.30 Grant reported that in 1991, 33 percent of Medicare patients with gastrostomies were aged 85 years or older.3' Finucane et al'3 reported that PEG tube placement in severely demented older adults does not always reduce the risk of decubiti, infection, or aspiration pneumonia, nor increase survival. Moreover, functional capacity and comfort level may not be markedly improved.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous endoscopic gastrostomy in cognitively impaired older adults: A geropsychiatric perspective

Detweiler¹,

Kim

Bass

2004

Am J Alzheimers Dis Other Demen

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The increasing use of percutaneous endoscopic gastrostomy (PEG) in cognitively compromised elderly presents complex treatment-related and ethical questions. Approximately half of all dementia patients will be unable to feed themselves within eight years of their diagnosis. Moreover, 85 percent of dementia patients have demonstrated refusal to eat. Geropsychiatry is often employed to evaluate these cognitively impaired patients either prior to or following PEG tube placement. This manuscript presents three cases to illustrate the most commonly encountered general dementia presentations: the ability to communicate with decisional capacity, the ability to communicate without decisional capacity, and severe verbal aphasia without decisional capacity. The study discusses ethical issues and treatment strategies for pre- and post-PEG tube placement consultations, including environmental interventions, in order to improve quality of life for this population.

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Section: Discussionmentioning

confidence: 99%

Percutaneous endoscopic gastrostomy in cognitively impaired older adults: A geropsychiatric perspective

Detweiler¹,

Kim

Bass

2004

Am J Alzheimers Dis Other Demen

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“…The microarray data by Eriksson et al, depicted an interesting biphasic expression level of STM1485 in macrophages being 90-fold at 4 h, 26-fold at 8 h and 113-fold at 12 h after infection 17 . Though the roles of mgt C, pag C, 20 adi Y 21 and cad B 18 acid inducible genes in Salmonella pathogenesis are known, the physiological role of one of the most highly induced genes STM1485 in Salmonella pathogenesis remains undetermined.…”

Section: Introductionmentioning

confidence: 99%

Acidic pH induced STM1485 gene is essential for intracellular replication of Salmonella

et al. 2012

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During the course of infection, Salmonella has to face several potentially lethal environmental conditions, one such being acidic pH. The ability to sense and respond to the acidic pH is crucial for the survival and replication of Salmonella. The physiological role of one gene (STM1485) involved in this response, which is upregulated inside the host cells (by 90- to 113-fold) is functionally characterized in Salmonella pathogenesis. In vitro, the ΔSTM1485 neither exhibited any growth defect at pH 4.5 nor any difference in the acid tolerance response. The ΔSTM1485 was compromised in its capacity to proliferate inside the host cells and complementation with STM1485 gene restored its virulence. We further demonstrate that the surface translocation of Salmonella pathogenicity island-2 (SPI-2) encoded translocon proteins, SseB and SseD were reduced in the ΔSTM1485. The increase in co-localization of this mutant with lysosomes was also observed. In addition, the ΔSTM1485 displayed significantly reduced competitive indices (CI) in spleen, liver and mesenteric lymph nodes in murine typhoid model when infected by intra-gastric route. Based on these results, we conclude that the acidic pH induced STM1485 gene is essential for intracellular replication of Salmonella.

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“…In Britain about two‐thirds of those with Alzheimer's disease will spend the last 1–3 years of their lives or longer in hospitals, nursing homes or residential homes possibly with some aspect of impaired ability to eat (Lennard‐Jones, 1998). Research conducted in Germany has shown that 40–50 per 100 000 nursing home beds are taken up by dementia patients who have had percutaneous endoscopic gastrostomies (PEG) inserted (Lindemann & Nikolaus, 2001). Patients with dementia are most frequently commenced on tube feeding with the objective of preventing aspiration pneumonia, malnutrition, skin breakdown and pressure sores and ultimately improving survival (Mitchell et al ., 1997; Finucane et al ., 1999).…”

Section: Introductionmentioning

confidence: 99%

Tube feeding controversial patients: what do dietitians think?

Healy¹,

McNamara

2002

J Human Nutrition Diet

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The use of tube feeding in some patients can be controversial, however, few studies have investigated dietitians' opinions on this subject. A cross-sectional survey of 345 members the Irish Nutrition and Dietetic Institute was conducted using a self-administered, anonymous, postal questionnaire. A 44% response rate was achieved. Mean number of years qualified was 9.3 (8.4). Eighty-one per cent of responders were involved in initiating tube feeding in stroke patients, and 8.5% in discontinuing tube feeding in a patient in a persistent vegetative state (PVS). Nine per cent felt that their input had no influence on the care plan of the patient with dementia and 67% felt that the information given to families (or other decision makers) concerning tube feeding was inadequate. The majority of respondents favoured tube feeding fictitious stroke and cancer patients, but less than half favoured tube feeding a fictitious patient in a PVS or a patient with dementia. When given similar scenarios involving themselves, fewer dietitians wanted to be tube fed.

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Outcomes of Percutaneous Endoscopic Gastrostomy in Dementia Patients

Cited by 7 publications

References 4 publications

Percutaneous endoscopic gastrostomy in cognitively impaired older adults: A geropsychiatric perspective

Percutaneous endoscopic gastrostomy in cognitively impaired older adults: A geropsychiatric perspective

Acidic pH induced STM1485 gene is essential for intracellular replication of Salmonella

Tube feeding controversial patients: what do dietitians think?

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