What is the comparison of dislodgment rates between low-profile and traditional gastrostomy (percutaneous endoscopic gastrostomy (PEG)) tubes in patients with dementia?

No Direct Comparative Data Available on Low-Profile vs Traditional Gastrostomy Tube Dislodgment in Dementia Patients

The available guidelines and research do not provide specific comparative data on dislodgment rates between low-profile (button) and traditional gastrostomy tubes specifically in patients with dementia. However, the evidence does address tube dislodgment in general populations and provides important context about gastrostomy tube use in dementia.

General Evidence on Tube Dislodgment

Nasogastric vs Percutaneous Tubes

• Tube dislodgement rates are lower with percutaneous devices compared to nasogastric tubes, and adequacy and duration of enteral feeding is greater with percutaneous devices 1
• Nasogastric tube dislodgement can occur in 40-80% of cases without proper fixation 2
• Frequent dislodgement of nasogastric tubes is associated with poor enteral nutrition delivery 1

Low-Profile Device Considerations

• Low-profile devices (buttons) may be beneficial as they are less likely to be dislodged 3
• This recommendation comes from general tube management guidelines, not dementia-specific studies 3

Dislodgment Prevention Strategies

• Consider mittens to reduce ability to grasp and pull tubes for patients at high risk of inadvertent removal, including those with delirium, dementia, or altered mental status 3
• Avoid abdominal binders as they increase side torsion and risk of stoma enlargement 3
• Implementation of a concise gastrostomy tube care protocol reduced unintended dislodgements from 29% to 5.9% at 90 days in one study 4

Critical Context: Gastrostomy Tubes in Dementia

Guideline Recommendations Against Routine Use

• Gastrostomy tubes should not be placed routinely in patients with advanced dementia, as there is no consistent benefit 1
• In patients with severe dementia, the risk-benefit ratio of enteral nutrition is unfavorable and enteral nutrition is generally not recommended 1
• Patients with chronic dementia are more likely to see their function or quality of life worsen following gastrostomy placement 1

Outcomes in Dementia Patients

• Patients with dementia had a 49% increased risk of mortality after PEG placement compared to those without dementia (adjusted for age and sex) 5
• Gastrostomy placement in patients with dementia probably does not change mortality, as death rate is more related to underlying disease process and comorbidities 1
• Converting from hand feeding to gastrostomy feeding deprives patients of touch, taste, nurturing, and social interaction 1

When Gastrostomy May Be Considered

• Select cases of dementia may warrant consideration for percutaneous gastrostomy 1
• PEG should be considered on an individual basis in patients with moderate-severe dementia when risk of malnutrition and aspiration is present 6
• The decision-making process is complicated and involves advance directives, ethical considerations, legal/financial concerns, emotional factors, cultural background, and religious beliefs 7

Common Pitfalls

• Placing gastrostomy tubes in advanced dementia based on assumptions about preventing aspiration, maintaining skin integrity, or prolonging life - evidence does not support these benefits 1, 7
• Patients with dementia are usually chemically or physically restrained following the procedure, and consequent immobility negates nutritional benefits 1
• The terminal phase of dementia (loss of speech and smile, difficulty eating) indicates lifespan remaining of less than 12-18 months 1