title: Mental incapacity in hospitalised patients undergoing percutaneous endoscopic gastrostomy insertion.
abstract: OBJECTIVE
  Decisions to insert percutaneous endoscopic gastrostomy (PEG) tubes may be difficult because patients have serious underlying disease, and the procedure has associated risks. Patients may also lack mental capacity to consent to PEG insertion. This study aimed to prospectively determine the prevalence of mental incapacity in hospitalised patients undergoing PEG insertion.
  
  
  METHODS
  Mental capacity was assessed using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) in 72 consecutive inpatients referred for PEG insertion. Cognitive function was measured using the Mini-Mental State Examination (MMSE). Sixty eight inpatients and 69 outpatients having diagnostic upper gastrointestinal (UGI) endoscopy were similarly studied.
  
  
  RESULTS
  Thirty nine of the PEG patients had suffered stroke, and none had a primary diagnosis of dementia. Seventy four % (53/72) of inpatients referred for PEG, 22% (15/68) of inpatients having UGI endoscopy, and 3% (2/69) of outpatients having UGI endoscopy, lacked mental capacity, p < 0.001. MMSE scores were normal in just 18% of inpatients having PEG, in 72% of inpatients having UGI endoscopy, and in 91% of outpatients having UGI endoscopy, p < 0.001.
  
  
  CONCLUSIONS
  Amongst inpatients undergoing PEG insertion there is a high prevalence (three-quarters patients) of mental incapacity to consent to this important intervention. Decisions have to be made on behalf of most inpatients referred for PEG insertion.
authors: Wycombe Hospital, Queen Alexandra Road, High Wycombe, Bucks HP11 2TT, United Kingdom.
authors: M
authors: M
authors: Rahman
authors: K E
authors: KE
authors: Evans
authors: N
authors: N
authors: Arif
authors: D A
authors: DA
authors: Gorard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003072:Cognition Disorders / Q000503:physiopathology* / Q000523:psychology; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D007258:Informed Consent; D007297:Inpatients / Q000523:psychology*; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome