Do not recommend PEG (Percutaneous Endoscopic Gastrostomy) in advanced dementia; instead, prefer assisted oral feeding.

Do not recommend PEG (Percutaneous Endoscopic Gastrostomy) in advanced dementia; instead, prefer assisted oral feeding.

Type of practice

Other treatments

Age

Adult, Geriatric

Topic Area

Hospital Internal Medicine

PEG or Nasogastric Tube placement should be limited to probable reversible conditions or for a short time period (e.g. post stroke, acute infections). The use of PEG is not recommended in patients affected by advanced dementia since it does not increase survival, does not reduce the risk of aspiration pneumonia, does not improve the healing of pressure ulcers; on the contrary it increases stress and the probability of physical containment and pharmacological sedation. The practice of comfort feeding (oral feeding for comfort purposes) aiming at improving human contacts rather than nutritional objectives allows a better perception by the patient, relatives (where adequately informed), and healthcare personnel of his/her life ending time.

Sources

1. Matarasso Greenfeld S, Gil E, Agmon M. A bridge to cross: tube feeding and the barriers to implementation of palliative care for the advanced dementia patient. J Clin Nurs 2022;31:1826-34. doi: 10.1111/jocn.15437.
2. Van Bruchem-Visser RL, Mattace-Raso FUS, de Beaufort ID, et al. Percutaneous endoscopic gastrostomy in older patients with and without dementia: Survival and ethical considerations. J Gastroenterol Hepatol 2019;34:736-41. doi: 10.1111/jgh.14573.
3. Roche KF, Bower KL, Collier B, et al. when should the appropriateness of PEG be questioned? Curr Gastroenterol Rep. 2023;25:13-9. doi: 10.1007/s11894-022-00857-2.
4. Schneider PL, Fruchtman C, Indenbaum J et al. Ethical considerations concerning use of percutaneous endoscopic gastrostomy feeding tubes in patients with advanced dementia. Perm J. 2021;25:20.302. doi: 10.7812/TPP/20.302.
5. Volkert D, Chourdakis M, Faxen-Irving G et al. ESPEN guidelines on nutrition in dementia. Clin Nutr 2015;34:1052-73. doi: 10.1016/j.clnu.2015.09.004.

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Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.