Should patients with end-stage vascular dementia receive a Percutaneous Endoscopic Gastrostomy (PEG) tube?

From the Guidelines

PEG tube placement is generally not recommended for patients with end-stage vascular dementia. The evidence suggests that artificial nutrition and hydration through feeding tubes does not improve survival, prevent aspiration pneumonia, reduce infections, improve functional status, or enhance quality of life in patients with advanced dementia 1. In fact, PEG tubes can lead to complications such as infection at the insertion site, tube dislodgement, and increased use of physical restraints to prevent patients from pulling out the tube.

Instead, careful hand feeding by caregivers is preferred as it allows for human interaction and comfort while providing nutrition as tolerated. This approach aligns with palliative care principles that focus on comfort and dignity rather than prolonging the disease process. The decision should ultimately involve discussions between healthcare providers and family members about the patient's previously expressed wishes, values, and goals of care, with an emphasis on comfort measures and quality of remaining life rather than extending life through artificial means.

Some key points to consider include:

• The lack of evidence supporting the use of artificial nutrition in patients with severe dementia 1
• The potential complications associated with PEG tube placement, such as infection and tube dislodgement 1
• The importance of individualized care plans, such as "comfort feeding", to avoid negative connotations and ensure patient-centered care 1
• The need for careful consideration of the patient's values, goals, and previously expressed wishes in making decisions about artificial nutrition and hydration.

Overall, the evidence suggests that careful hand feeding is the preferred approach for patients with end-stage vascular dementia, rather than PEG tube placement, in order to prioritize comfort, dignity, and quality of life.

From the Research

End Stage Vascular Dementia Patients and PEG Tubes

• The use of PEG tubes in patients with end stage vascular dementia is a complex issue, with various studies suggesting that it may not be beneficial for these patients 2, 3, 4, 5, 6.
• A study published in the Journal of Clinical Gastroenterology found that PEG insertion in patients with dementia did not improve nutritional status, reduce rehospitalization rates, or improve survival rates compared to patients with other indications for PEG placement 2.
• The American Geriatrics Society recommends against the use of feeding tubes in older adults with advanced dementia, citing a lack of evidence for their effectiveness and potential risks such as agitation, physical and chemical restraints, and pressure ulcers 3.
• A review of the literature on enteral tube feeding for people with severe dementia found that the balance of benefits and harms is not clear, and that the use of enteral tube feeding is not recommended for these patients 5.
• A study published in the Journal of Gastroenterology and Hepatology found that patients with dementia who underwent PEG tube placement had a significantly shorter survival time compared to patients without dementia, and that the insertion of a PEG tube in patients with dementia is not appropriate 6.
• The decision to use a PEG tube in a patient with end stage vascular dementia should be made on a case-by-case basis, taking into account the patient's individual needs, preferences, and values, as well as the potential risks and benefits of the procedure 4.

Key Findings

• PEG tube placement does not improve nutritional status or survival rates in patients with dementia 2.
• The use of enteral tube feeding is not recommended for patients with severe dementia due to a lack of evidence for its effectiveness and potential risks 3, 5.
• Patients with dementia who undergo PEG tube placement have a significantly shorter survival time compared to patients without dementia 6.
• The decision to use a PEG tube in a patient with end stage vascular dementia should be made on a case-by-case basis, taking into account the patient's individual needs and preferences 4.

Considerations for Healthcare Providers

• Healthcare providers should carefully consider the potential risks and benefits of PEG tube placement in patients with end stage vascular dementia 2, 3, 4, 5, 6.
• Patients and their families should be fully informed about the potential risks and benefits of PEG tube placement, and should be involved in the decision-making process 4.
• Alternative methods of nutrition and hydration, such as hand feeding, should be considered for patients with end stage vascular dementia 3.