Long-Term Survival of Patients Receiving Artificial Nutrition in Japanese Psychiatric Hospitals

Background/Aims: Most patients with dementia suffer from dysphagia in the terminal stage of the disease. In Japan, most elderly patients with dysphagia receive either tube feeding or total parenteral nutrition. Methods: In this study, we investigated the factors determining longer survival with artificial nutrition. Various clinical characteristics of 168 inpatients receiving artificial nutrition without oral intake in psychiatric hospitals in Okayama Prefecture, Japan, were evaluated. Results: Multiple logistic regression analysis showed that the duration of artificial nutrition was associated with a percutaneous endoscopic gastrostomy (PEG) tube, diagnosis of mental disorder, low MMSE score, and absence of decubitus. Conclusion: Patients with mental disorders survived longer than those with dementia diseases on artificial nutrition. A PEG tube and good nutrition seem to be important for long-term survival.

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Tube Feeding in Advanced Dementia: An Exploratory Survey of Physician Knowledge

Care Management Journals ◽

10.1891/cmaj.7.2.79 ◽

2006 ◽

Vol 7 (2) ◽

pp. 79-85 ◽

Cited By ~ 17

Author(s):

Caroline A. Vitale ◽

Tad Hiner ◽

Wayne Ury ◽

Cathy Berkman ◽

Judith C. Ahronheim

Keyword(s):

Primary Care Physicians ◽

Tube Feeding ◽

Mail Survey ◽

Current Evidence ◽

Artificial Nutrition ◽

Advanced Dementia ◽

Significant Treatment ◽

Physician Knowledge ◽

Endoscopic Gastrostomy ◽

Peg Tube

The administration of artificial nutrition by means of a percutaneous endoscopic gastrostomy (PEG) tube in older persons in the advanced stages of dementia is commonplace, yet the treatment is associated with significant treatment burdens and unclear benefits in this population. In addition, there is wide and unexplained geographic variability in the use of PEG in advanced dementia, which may stem partly from physicians’ lack of understanding about its indications, risks, benefits, and effect on quality of life in advanced dementia. This study was a mail survey undertaken to assess physician knowledge regarding tube feeding in advanced dementia and explore whether certification in geriatrics or other physician characteristics are associated with physician knowledge. To assess knowledge about tube feeding, we asked participants to rate the importance of commonly cited, but non–evidence based, indications for tube feeding in advanced dementia, including recurrent aspiration pneumonia, abnormal swallowing evaluations, abnormal nutritional parameters, preventing an uncomfortable death, and others. Discrepancies between physician knowledge and current evidence regarding tube feeding in advanced dementia were found, indicating a need for improved education of primary care physicians in order to ultimately provide better end-of-life care for patients with advanced dementia.

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Prospective Cohort Study Comparing the Effects of Different Artificial Nutrition Methods on Long‐Term Survival in the Elderly

Journal of Parenteral and Enteral Nutrition ◽

10.1177/0148607114522486 ◽

2014 ◽

Vol 39 (4) ◽

pp. 456-464 ◽

Cited By ~ 5

Author(s):

Seiji Bito ◽

Tetsuo Yamamoto ◽

Harumi Tominaga ◽

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

The Elderly ◽

Artificial Nutrition ◽

Term Survival ◽

Long Term Survival

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New "introducer" PEG-gastropexy with T fasteners: a pilot study

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032011000400003 ◽

2011 ◽

Vol 48 (4) ◽

pp. 231-235 ◽

Cited By ~ 8

Author(s):

Fernanda Prata Martins ◽

Maris Celia Batista de Sousa ◽

Angelo Paulo Ferrari

Keyword(s):

Oral Intake ◽

Prophylactic Antibiotics ◽

Success Rates ◽

Procedure Time ◽

Endoscopic Gastrostomy ◽

Post Procedure ◽

Enteral Access ◽

Procedure Duration ◽

Peg Tube

CONTEXT: Enteral feeding is indicated for patients unable to maintain appropriate oral intake, and percutaneous endoscopic gastrostomy (PEG) is the most adequate long-term enteral access. Peristomal infections are the most common complications of PEG, occurring in up to 8% of patients, despite the use of prophylactic antibiotics. The "introducer" PEG-gastropexy technique avoids PEG tube passage through the oral cavity, preventing microorganisms' dislodgment to the peristomal site. OBJECTIVES: To compare the incidence of peristomal wound infection at 7-day post-procedure after conventional "pull" technique versus a new "introducer" PEG-gastropexy kit. Secondary outcomes included success rates, procedure time, and other complications. METHODS: Eighteen patients referred for PEG placement between June and December 2010 were randomly assigned to "pull" PEG with antibiotics or "introducer" PEG-gastropexy technique without antibiotics. RESULTS: Overall success rate for both methods was 100%, although mean procedure duration was higher in the "introducer" PEG-gastropexy group (12.6 versus 6.4 minutes, P = 0.0166). Infection scores were slightly higher in patients who underwent "pull" PEG with antibiotics compared with "introducer" PEG-gastropexy without antibiotics (1.33 ± 0.83 versus 0.75 ± 0.67, P = 0.29). CONCLUSION: Although procedure duration was longer in the "introducer" PEG-gastropexy, infection scores were marginally higher in the "pull" PEG technique.

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