title: Long-term follow-up of consequences of percutaneous endoscopic gastrostomy (PEG) tubes in nursing home patients.
abstract: PEG (percutaneous endoscopic gastrostomy) tubes are frequently placed in nursing home patients. The aim of this study was to assess retrospectively the long-term changes in functional and nutritional statuses, tube-related complications, and factors influencing survival in 46 nursing home residents, mean age 73.6 years (range 19-96). Functional status was evaluated by a standard rehabilitation medicine scale. Nutritional status was evaluated by serum albumin and cholesterol concentrations and by weight. PEG-related complications requiring hospitalization or emergency room or clinic evaluations were noted. Additionally, changes in resuscitation status were noted. The predominant indication for PEG placement was dementia (52%). At PEG placement, 48% of patients had total functional impairment. Regardless of the severity of impairment, no patient's functional status improved after PEG. Nutritional status did not improve significantly. Mortality approached 50% and 60% at 12 and 18 months, respectively, and was significantly related to age, resuscitation status, and serum albumin concentration. All patients under 40 years of age at PEG survived, in contrast to 41.3% of patients over 40 years of age (P < 0.001). Sixty-three percent of patients who were "full code" at PEG placement survived, in contrast to 10% of "no code" patients (P < 0.001). Albumin > or = 3.5 g/dl at PEG or thereafter was associated with improved survival (P < 0.001) as compared to albumin < 3.5 g/dl. PEG-related complications occurred in 34.7% of patients, and the first occurred four months after PEG. We conclude that realistic expectations of what PEG can accomplish be a factor in the decision to place a PEG tube in nursing home patients.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Pittsburgh School of Medicine, Pennsylvania 15213.
authors.forename: M
authors.initials: M
authors.lastname: Kaw
authors.forename: G
authors.initials: G
authors.lastname: Sekas
mesh_terms: D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000628:therapy*; D003704:Dementia / Q000628:therapy*; D004750:Enteral Nutrition; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000401:mortality; D009735:Nursing Homes; D009752:Nutritional Status; D016414:Resuscitation Orders; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D012709:Serum Albumin