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Percutaneous Endoscopic Gastrostomy in the Enteral Feeding of the Elderly

Authors :
Huan-Lin Chen
Shou-Chuan Shih
Ming-Jong Bair
I.-Tsung Lin
Chia-Hsien Wu
Source :
International Journal of Gerontology, Vol 5, Iss 3, Pp 135-138 (2011)
Publication Year :
2011
Publisher :
Taiwan Society of Geriatric Emergency and Critical Medicine (TSGECM), 2011.

Abstract

Today we are faced with an aging society that may develop malnutrition because of dysphagia related to dementia, stroke, and malignancy seen often in the elderly. The preferred form of nutritional supplementation for this group is enteral nutrition, and the most appropriate long-term method is by use of a gastrostomy. Percutaneous endoscopic gastrostomy (PEG) was first introduced in 1980 as an alternative to the traditional operative procedure and rapidly became the preferred procedure. In geriatric patients, the principal indications are neurological dysphagia and malnutrition, related to an underlying disease or anorexia-cachexia in very elderly. PEG is contraindicated in the presence of respiratory distress, previous gastric resection, total esophageal obstruction, coagulation disorders and sepsis in the elderly. Common complications include wound infection, leakage, hemorrhage, and fistula in the general population, but aspiration pneumonia is the major case of death in this group. Risks and complications of PEG must be discussed with patients and their families; and the decision for percutaneous endoscopic gastrostomy insertion should only be made after careful consideration and discussion between managing physicians, allied health professionals, and the patient and/or family. Four ethical principles may help make feeding decisions: beneficence, non-maleficence, autonomy and justice. Attentive long-term care after tube replacement is mandatory. Acceptance of percutaneous endoscopic gastrostomy placement by patients and their families tends to increase once favorable outcomes are offered.

Details

Language :
English
ISSN :
18739598
Volume :
5
Issue :
3
Database :
Directory of Open Access Journals
Journal :
International Journal of Gerontology
Publication Type :
Academic Journal
Accession number :
edsdoj.5566f95a464044d0ac2094e082ccb824
Document Type :
article
Full Text :
https://doi.org/10.1016/j.ijge.2011.09.040