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Outcomes of Percutaneous Endoscopic Gastrostomy Among Older Adults in a Community Setting
Author(s) -
Callahan Christopher M.,
Haag Kathy M.,
Weinberger Morris,
Tierney William M.,
Buchanan Nancy N.,
Stump Timothy E.,
Nisi Rod
Publication year - 2000
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2000.tb04779.x
Subject(s) - medicine , percutaneous endoscopic gastrostomy , quality of life (healthcare) , gastrostomy , parenteral nutrition , comorbidity , prospective cohort study , enteral administration , cohort , feeding tube , pediatrics , intensive care medicine , peg ratio , surgery , nursing , finance , economics
OBJECTIVE : Percutaneous endoscopic gastrostomy (PEG) has become the preferred method to provide enteral tube feeding to older adults who have difficulty eating, but the impact of PEG on patient outcomes is poorly understood. The objective of this study was to describe changes in nutrition, functional status, and health‐related quality of life among older adults receiving PEG. DESIGN : A prospective cohort study. SETTING : A small community of approximately 60,000 residents served by two hospital systems. PARTICIPANTS : One hundred fifty patients aged 60 and older receiving PEG from one of the four gastroenterologists practicing in the targeted community. MEASUREMENTS : Patients were assessed at baseline and every 2 months for 1 year to obtain clinical characteristics, process of care data, physical and cognitive function, subjective health status, nutritional status, complications, and mortality. RESULTS : Over a 14‐month period, 150 patients received PEG tubes in the targeted community; the mean age was 78.9. The most frequent indications for the PEG were stroke (40.7%), neurodegenerative disorders (34.7%), and cancer (13.3%). All measures of functional status, cognitive status, severity of illness, comorbidity, and quality of life demonstrated profound and life‐threatening impairment; 30‐day mortality was 22% and 1‐year mortality was 50%. Among patients surviving 60 days or more, at least 70% had no significant improvement in functional, nutritional, or subjective health status. Serious complications were rare, but most patients experienced symptomatic problems that they attributed to the enteral tube feeding. CONCLUSIONS : PEG tube feeding in severely and chronically ill older adults can be accomplished safely. However, there are important patient burdens associated with the PEG and there was limited evidence that the procedure improves functional, nutritional, or subjective health status in this cohort of older adults. The issues raised in this descriptive study provide impetus for a randomized trial of PEG tube feeding compared with alternative methods of patient care for older adults with difficulty eating.