Physician opinions on decision making for percutaneous endoscopic gastrostomy (PEG) feeding tube placement

Fessler, Theresa A.; Short, Timothy B; Willcutts, Kate; Sawyer, Robert G.

doi:10.1007/s00464-019-06711-3

Cited by 9 publications

(3 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Increased risk of feeding tube placement was observed in those with greater cognitive impairment and ADL dependence, suggesting these patients were at more advanced stages of the disease. Despite mounting evidence suggesting otherwise, 17,39,42,43 two recent surveys conducted assessing physician knowledge of feeding tubes found that >56% disagreed PEG tubes were contraindicated in patients with dementia; 62% believed that feeding tubes prevented aspiration; and 52% thought feeding tubes prevented pneumonia 44,45 . Therefore, healthcare providers may be continuing to place feeding tubes in patients with advanced dementia due to continued knowledge gaps regarding their clinical benefit.…”

Section: Discussionmentioning

confidence: 99%

Pre‐hospitalization dysphagia and feeding tube placement in nursing home residents with advanced dementia

Robison,

Patel,

Bunker

et al. 2023

J American Geriatrics Society

View full text Add to dashboard Cite

BackgroundDespite research demonstrating the risks of using feeding tubes in persons with advanced dementia, they continue to be placed. The natural history of dysphagia among patients with advanced dementia has not been examined. We conducted a secondary analysis of a national cohort of persons with advanced dementia staying at a nursing home stay before hospitalization to examine (1) pre‐hospitalization dysphagia prevalence and (2) risk of feeding tube placement during hospitalization based on preexisting dysphagia.MethodsA retrospective cohort study consisting of all nursing home (NH) residents (≥66 years) with advanced dementia (Cognitive Function Scale score ≥2), a hospitalization between 2013–2017, and a Minimum Data Set (MDS) 3.0 assessment within 120 days before hospitalization. Pre‐hospitalization dysphagia status and surgically placed feeding tube insertion during hospitalization were determined by MDS 3.0 swallowing items and ICD‐9 codes, respectively. A multivariate logistic model clustering on hospital was used to examine the association of dysphagia with percutaneous endoscopic gastrostomy (PEG) feeding tube placement after adjustment for confounders.ResultsBetween 2013 and 2017, 889,983 persons with NH stay with advanced dementia (mean age: 84.5, SD: 7.5, and 63.5% female) were hospitalized. Pre‐hospitalization dysphagia was documented in 5.4% (n = 47,574) and characterized by oral dysphagia (n = 21,438, 2.4%), pharyngeal dysphagia (n = 24,257, 2.7%), and general swallowing complaints/pain (n = 14,928, 1.7%). Overall, PEG feeding tubes were placed in 3529 patients (11.2%) with pre‐hospitalization dysphagia, whereas 27,893 (88.8%) did not have pre‐hospitalization dysphagia according to MDS 3.0 items. Feeding tube placement risk increased with the number of dysphagia items noted on the pre‐hospitalization MDS (6 vs. 0 dysphagia variables: OR = 5.43, 95% CI: 3.19–9.27).ConclusionsBased on MDS 3.0 assessment, only 11% of PEG feeding tubes were inserted in persons with prior dysphagia. Future research is needed on whether this represents inadequate assessment or the impact of potentially reversible intercurrent illness resulting in feeding tube placement.

show abstract

Section: Discussionmentioning

confidence: 99%

Pre‐hospitalization dysphagia and feeding tube placement in nursing home residents with advanced dementia

Robison,

Patel,

Bunker

et al. 2023

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…In carrying out this review it was possible to see how the decision to start enteral nutrition in dementia (especially in its advanced stage), is often controversial and influenced by clinical reasons, by the context in which we are called to operate, or by the doubtful availability and legitimacy of advance directives for the treatment of patients. 28 Moreover, cultural-religious convictions of health personnel and family members, emotional experience linked to the illness, and legal implications are among the most important factors to take in account. 29 The choice to perform this procedure becomes complex in the case in which it must be operated against a person suffering from cognitive impairment, or where the patient's involvement is limited by the underlying pathology, since it becomes necessary to reconstruct the will, guaranteeing compliance with the system of the values, of the convictions that he expressed during his life, as the dementia patient must be recognized as a person, at every stage of his illness, regardless of the change in cognitive conditions, gradual or immediate or change of personality and behavior.…”

Section: Ethical and Legal Considerationsmentioning

confidence: 99%

“…If it is started it must be interrupted if it causes complications or symptoms to the patient. 28,30 The role of nurses in the enteral nutrition in dementia tions and in supporting caregivers. 31 According to the new deontological Italian code …the nurse enhances and welcomes the person's contribution, his point of view and his emotions and facilitates the expression of suffering.…”

Section: Ethical and Legal Considerationsmentioning

confidence: 99%

Importance of quality of life in people with dementia treated with enteral nutrition: the role of the nurse

Veronese

Minto

Bonso³

et al. 2019

Geriatr Care

View full text Add to dashboard Cite

Nutritional problems are common in dementia and can lead to enteral nutrition, a nutritional treatment option in severe stages of dementia. However, the benefits of enteral nutrition in people with dementia are still weak. The decision to use artificial nutrition in these patients is often emotional and complex and the attitudes of health personnel (physicians and nurses) in this sense they are very different. The objective of this review is to show the role of enteral nutrition on quality of life in patients affected by dementia and the possible implications for practice and research, with a special focus on nurse role. We made a literature search in PubMed and Scopus, searching for studies dealing with enteral nutrition and quality of life in dementia. We were able to find only a few observational studies related to enteral nutrition and quality of life, with a lack in the scientific literature regarding the management of nutritional problems in dementia, particularly taking in account quality of life. Furthermore, by orienting the research on a possible role of nurses, there were limited studies on properly nursing aspects. From this work emerges the need for further research in this context for which the training and education of health personnel result of fundamental importance, with a view to improving the quality of life of the patients with dementia and their family.

show abstract

Tube Feeding: Techniques and Procedure

Sohagia¹,

Hertan²

2021

Geriatric Gastroenterology

View full text Add to dashboard Cite

Physician opinions on decision making for percutaneous endoscopic gastrostomy (PEG) feeding tube placement

Cited by 9 publications

References 31 publications

Pre‐hospitalization dysphagia and feeding tube placement in nursing home residents with advanced dementia

Pre‐hospitalization dysphagia and feeding tube placement in nursing home residents with advanced dementia

Importance of quality of life in people with dementia treated with enteral nutrition: the role of the nurse

Tube Feeding: Techniques and Procedure

Contact Info

Product

Resources

About