Summary and Comment
Feeding Tubes in Patients with Advanced Dementia
Tube feedings did not extend life in a nursing home cohort.
Some surrogate decision makers opt for placing percutaneous endoscopic gastrostomy (PEG) tubes to prolong life in patients with advanced dementia. Researchers used the Minimum Data Set (a federally mandated comprehensive assessment of nursing home residents) and Medicare claims data to determine whether PEG tubes actually delayed death in 36,000 nursing home residents with advanced dementia who had recently transitioned to a need for assistance with eating.
Five percent of patients received PEG tubes during the study period. In multivariate analyses adjusted for clinical differences between the PEG and no-PEG groups, 1-year survival was virtually identical in the two groups — about 50%.
Comment: The authors conclude that PEG feedings do not prolong life in patients with dementia who need assistance with eating. However, baseline characteristics of the PEG and no-PEG groups were so unbalanced (with significantly more comorbidity and impairment in the PEG group) that residual confounding is likely. Moreover, artificial nutrition and hydration might delay death, at least briefly, in some patients who have stopped eating and drinking altogether. My preference is to move family discussions away from whether PEG tubes prolong life and to focus on whether the patient really would have wanted a PEG tube — an invasive intervention that requires ongoing professional management — in a state of advanced dementia near the end of life.
Published in Journal Watch General Medicine October 30, 2012
