Percutaneous Endoscopic Gastrostomy Tube Removal for Patients With Advanced Dementia: Case Series Study

Abstract

Background Although the notion of percutaneous endoscopic gastrostomy (PEG) tube placement for patients with dementia has been changing, the number of cases of PEG placement remains high as Japan has become a super-aged society. However, there is insufficient research about the clinical course of dementia patients with PEG, especially regarding PEG extubation after regaining full oral intake. This case series aimed to reveal the demographic data of patients who successfully underwent PEG extubation and to identify clinical factors that might help predict eventual resumption. Methods This retrospective case series was identified in a private, community-based long-term care hospital in Sapporo, Japan. Inclusion criteria for the series were: 1) age, ≥75 years, 2) diagnosis of any type of dementia, and 3) resumption of full oral intake after removal of PEG tubes. Results Eight female patients were identified. Decreased oral intake was triggered by acute medical conditions, such as infectious enteritis. A trial of oral intake was initiated mostly by speech therapists. A majority of the patients ate pureed food. The patients aged ≥85 years with advanced dementia could be weaned from PEG tubes. Conclusion The series indicates that even patients with limited life expectancy could recover swallowing function by receiving appropriate guidance and care. Constant evaluation for swallowing function even after PEG insertion may be important for PEG extubation.

Challenges and Opportunities for Academic Journals to Serve the Older Population in Western Pacific Region

“…“What matters” (i.e., one of the four cornerstones of the age-friendly health system framework) 11 ) is also affected by the social characteristics of populations. While research diversity in aging is considered a pressing issue in the United States, 12 ) knowledge gaps among different societies have been less addressed globally.…”

“…For instance, providing nutritional support through enteral access has been considered a default in many Asian societies, even in patients with advanced dementia, even though tube feeding in these patients is clinically controversial. 12 , 13 ) Similarly, a recent study suggested that socio-cultural factors pose barriers in initiating discussions about advance care planning in older persons with dementia. 14 ) Specifically, in Chinese culture, discussing matters related to death has been considered taboo.…”

Annals of Geriatric Medicine and Research as a Space of for Developing Research Ideas into Better Clinical Practices for Older Adults in Emerging Countries

“…To bolster the development of research ideas for older populations in our region, our journal is eager to receive research on population-or region-specific issues, with varying levels of evidence, including qualitative research such as narrative studies, small-scale case series, or proof-of-concept pilot studies. For example, a study from Japan by Hattori et al 5) describing cases of successful removal of percutaneous endoscopic gastrostomy tubes in patients with advanced dementia reflects unique cultural characteristics in East Asian countries regarding the importance of providing oral or enteral nutrition even to terminally frail patients. Similarly, a study from Brunei by Akbar et al 6) reports the perspectives of healthcare providers, including the cultural characteristics of Asian countries in terms of hierarchies among professionals and mood or pain status in less-expressive patients.…”