title: Percutaneous endoscopic gastrostomy (PEG) tubes are placed in elderly adults in Japan with advanced dementia regardless of expectation of improvement in quality of life.
abstract: BACKGROUND
  The Japan Geriatrics Society published a guideline on the decision-making process for health care for the elderly in June 2012, noting that withholding or withdrawing feeding tubes are treatment options that should be discussed during the decision-making process. Arguments against the guideline posit that the insertion of a percutaneous endoscopic gastrostomy (PEG) tube feeding may improve quality of life (QOL) for elderly adults and their relatives.
  
  
  OBJECTIVE
  The aim of the present study was to explore (a) expected outcomes with PEG tube placement and (b) outcomes from PEG tube feeding in long-term care settings among elderly adults with advanced dementia in Japan.
  
  
  METHODS
  This study was conducted using a cross-sectional study design.
  
  
  METHODS
  A total of 381 hospitals and 985 long-term care facilities provided sets of completed questionnaires.
  
  
  METHODS
  There were 1 199 hospital patients and 2 160 long-term care patients aged 65 years or older with PEG tube placement included in the analysis.
  
  
  METHODS
  The nurses or physicians at each hospital provided information on the level of dementia at the time of PEG tube placement and on the expected outcomes of PEG tube feeding for elderly hospital patients. The nurses or other direct care workers at each facility provided information on the level of dementia and outcomes from PEG tube feeding for the long-term care patients.
  
  
  RESULTS
  In the hospital patient group, 62.9% of patients had advanced dementia. PEG tube feeding was expected to prolong survival for 51.1% of hospital patients with advanced dementia. Improved QOL was expected for 39.1% of them. In the long-term care patient group, 61.7% of patients had advanced dementia. The rate of patients enjoying their own lives was lower in long-term care patients who had advanced dementia (4.2%) than in the other patients (16.4%). Approximately 60% of relatives reported satisfaction with the QOL of the patients, both in the long-term care patients with advanced dementia and the other patients.
  
  
  CONCLUSIONS
  Our results question the assumption that PEG tube feeding may improve QOL among elderly adults with advanced dementia. The national health policy should explore an approach to help patients, relatives, and practitioners make decisions about feeding options.
authors.affiliation: Miharu Nakanishi, PhD, Institute for Health Economics and Policy, 1-5-11 Nishishinbashi, Minato-ku Tokyo, 105-0003 Japan. Tel: +81 (3) 3506-8529; FAX: +81 (3) 3506-8528; E-mail: mnakanishi-tky@umin.ac.jp.
authors.forename: M
authors.initials: M
authors.lastname: Nakanishi
authors.forename: K
authors.initials: K
authors.lastname: Hattori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003657:Decision Making; D003704:Dementia / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D004724:Endoscopy / Q000706:statistics & numerical data*; D004750:Enteral Nutrition / Q000706:statistics & numerical data*; D005260:Female; D005774:Gastrostomy / Q000706:statistics & numerical data*; D015577:Geriatric Assessment; D005853:Geriatrics / Q000379:methods; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000706:statistics & numerical data*; D007564:Japan; D008134:Long-Term Care / Q000379:methods; D008297:Male; D009752:Nutritional Status; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome