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      International Survey of Physicians’ Perspectives on Percutaneous Endoscopic Gastrostomy Tube Feeding in Patients with Dementia and Review of Literature

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          Abstract

          Percutaneous endoscopic gastrostomy (PEG) tube often remains to be used as a primary modality for feeding in patients with advanced dementia, perhaps due to misconceptions regarding the outcomes. Physicians' perceptions regarding the PEG tubes could be a significant contributing factor globally. A multidisciplinary approach involving the ethics committee can help address the issue. Our survey is focused on gauging physicians' perceptions regarding PEG tube utilization and its global impact on outcomes in dementia.

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          ESPEN guidelines on nutrition in dementia.

          Dorothee Volkert, Michael Chourdakis, Gerd Faxén-Irving … (2015)
          Older people suffering from dementia are at increased risk of malnutrition due to various nutritional problems, and the question arises which interventions are effective in maintaining adequate nutritional intake and nutritional status in the course of the disease. It is of further interest whether supplementation of energy and/or specific nutrients is able to prevent further cognitive decline or even correct cognitive impairment, and in which situations artificial nutritional support is justified.
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            Evaluation and management of oropharyngeal dysphagia in different types of dementia: a systematic review.

            Kannayiram Alagiakrishnan, Rahima A Bhanji, Mini Kurian (2013)
            Dysphagia, or swallowing impairment, is a growing concern in dementia and can lead to malnutrition, dehydration, weight loss, functional decline, and fear of eating and drinking as well as a decrease in quality of life (QOL).
            Article 0 comments Cited 87 times – based on 0 reviews     Review now
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              American Geriatrics Society feeding tubes in advanced dementia position statement.

              (2014)
              When eating difficulties arise, feeding tubes are not recommended for older adults with advanced dementia. Careful hand feeding should be offered because hand feeding has been shown to be as good as tube feeding for the outcomes of death, aspiration pneumonia, functional status, and comfort. Moreover, tube feeding is associated with agitation, greater use of physical and chemical restraints, healthcare use due to tube-related complications, and development of new pressure ulcers. Efforts to enhance oral feeding by altering the environment and creating patient-centered approaches to feeding should be part of usual care for older adults with advanced dementia. Tube feeding is a medical therapy that an individual's surrogate decision-maker can decline or accept in accordance with advance directives, previously stated wishes, or what it is thought the individual would want. It is the responsibility of all members of the healthcare team caring for residents in long-term care settings to understand any previously expressed wishes of the individuals (through review of advance directives and with surrogate caregivers) regarding tube feeding and to incorporate these wishes into the care plan. Institutions such as hospitals, nursing homes, and other care settings should promote choice, endorse shared and informed decision-making, and honor preferences regarding tube feeding. They should not impose obligations or exert pressure on individuals or providers to institute tube feeding.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 30 April 2019
                Publication date (Electronic, collection): April 2019
                Volume: 11
                Issue: 4
                Electronic Location Identifier: e4578
                Affiliations
                [1 ] Gastroenterology, Mid Cheshire Hospitals National Health Service Foundation Trust, Crewe, GBR
                [2 ] Gastroenterology, Flinders Medical Centre, Adelaide, AUS
                [3 ] Gastroenterology, PSG Institute of Medical Sciences and Research, Coimbatore, IND
                [4 ] Miscellaneous, University of Illinois, Springfield, USA
                [5 ] Critical Care Medicine, Springfield Clinic, Springfield, USA
                Author notes
                Article
                DOI: 10.7759/cureus.4578
                PMC ID: 6605970
                SO-VID: bf3c5ec5-0604-46ff-a3a5-7e122f548eee
                Copyright © Copyright © 2019, Mohandas et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 19 April 2019
                Date accepted : 30 April 2019
                Categories
                Subject: Family/General Practice
                Subject: Internal Medicine
                Subject: Gastroenterology

                Keywords: peg tube,advanced dementia,physician's perspectives,complications associated with peg,percutaneous endoscopic gastrostomy,enteral access,feeding tube,nutrition,aspiration following peg,quality of life with peg
                Data availability:
                Keywords: peg tube, advanced dementia, physician's perspectives, complications associated with peg, percutaneous endoscopic gastrostomy, enteral access, feeding tube, nutrition, aspiration following peg, quality of life with peg

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