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[Dysphagia] PEG inadvisability in end stage dementia
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Finucane, T.E., C. Christmas, and K. Travis, Tube feeding in patients with advanced dementia: a review of the evidence. Jama, 1999. 282(14): p. 1365-70.
Patients with advanced dementia frequently develop eating difficulties and weight loss. Enteral feeding tubes are often used in this situation, yet benefits and risks of this therapy are unclear. We searched MEDLINE, 1966 through March 1999, to identify data about whether tube feeding in patients with advanced dementia can prevent aspiration pneumonia, prolong survival, reduce the risk of pressure sores or infections, improve function, or provide palliation. We found no published randomized trials that compare tube feeding with oral feeding. We found no data to suggest that tube feeding improves any of these clinically important outcomes and some data to suggest that it does not. Further, risks are substantial. The widespread practice of tube feeding should be carefully reconsidered, and we believe that for severely demented patients the practice should be discouraged on clinical grounds.
Rabeneck, L., L.B. McCullough, and N.P. Wray, Ethically justified, clinically comprehensive guidelines for percutaneous endoscopic gastrostomy tube placement. Lancet, 1997. 349(9050): p. 496-8.
Guidelines for the placement of percutaneous endoscopic gastrostomy (PEG) tubes are not available. We developed a decision-making algorithm by integrating the medical and ethical dimensions of the decision. According to our algorithm, physicians should not offer PEG tubes to patients with anorexia-cachexia syndromes. For patients with permanent vegetative states, physicians should offer and recommend against the procedure. For patients who have dysphagia without other deficits in quality of life, physicians should offer and recommend the procedure. For the the remaining patients who have dysphagia with other deficits in quality of life, the physician's role is to provide non-directive counselling regarding the short and long-term consequences of a trial of PEG tube feeding.
Regards,
Claire
----- Original Message -----
From: "Dolinger, Eric" <EDolinger@christianacare.org>
To: <Namp304@aol.com>; <dysphagia@b9.com>
Sent: Saturday, April 30, 2005 1:39 AM
Subject: RE: [Dysphagia] PEG inadvisability in end stage dementia
> Rethinking the Role of Tube Feeding in Patients with Advanced Dementia
> Gillick M. R.
> N Engl J Med 2000; 342:206-210, Jan 20, 2000.
>
> Eric Dolinger, MA CCC-SLP
> Senior Speech Pathologist
> Christiana Care Health System
> Phone 302-733-1015
> Fax 302-733-1061
>
> edolinger@christianacare.org
>
>
> -----Original Message-----
> From: Namp304@aol.com [mailto:Namp304@aol.com]
> Sent: Friday, April 29, 2005 1:33 PM
> To: dysphagia@b9.com
> Subject: [Dysphagia] PEG inadvisability in end stage dementia
>
>
> Dear List,
>
> Within the last few years, I thought there was a published statement, from
> some authoritative group such as the AMA, which outlined the lack of
> evidence
> for tube feeding efficacy in late/end-stage dementia. Was I dreaming this?
> If
> not, does anyone have a reference?
>
> Thank you,
> Nancy Parkinson
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