Survival after percutaneous endoscopic gastrostomy: the role of dementia.
BACKGROUND
Percutaneous Endoscopic Gastrostomy (PEG) is a widely used technique for enteral feeding in nursing home patients. Several factors including malnutrition, hypoalbuminemia, older age, number of co-morbidities and cognitive impairment adversely affect survival.


OBJECTIVE
This study evaluated the relative impact of age, serum albumin, number of co-morbid illnesses and dementia on survival in male nursing home patients who had undergone percutaneous endoscopic gastrostomy (PEG).


METHODS
In a retrospective study the hospital records of all North Chicago Veterans Affair (VA) male nursing home residents (n=88) who had PEG placed between 1990 through 2000 were reviewed. Of the 88 charts reviewed, 17 were eliminated from analysis due to incomplete data. Following data was examined: Age, serum albumin, number of co-morbid illnesses, presence of dementia, survival in years following PEG placement.


RESULTS
Advancing age was associated with increasing probability of dementia and increased number of co-morbidities. Post PEG survival decreased with increasing age, with lower serum albumin, and increased number of co-morbidities. Age and serum albumin were strong predictors of survival in PEG recipients without the diagnosis of dementia. However, in PEG recipients with a diagnosis of dementia, age and serum albumin no longer predicted survival. Dementia appears to attenuate the effects of age and serum albumin on survival following PEG placement.


CONCLUSIONS
In the presence of dementia, none of the usual predictors of survival in PEG recipients remain significant.
Gastroenterology Section, Medical Service, VA Medical Center, 3001 Green Bay Road, North Chicago, IL 60064, USA. Pallavi.Shah@med.va.gov
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D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology*; D004750:Enteral Nutrition / Q000379:methods; D005774:Gastrostomy / Q000401:mortality*; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D009752:Nutritional Status; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D016019:Survival Analysis
D012709:Serum Albumin