General

PEG or NO PEG

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31 Aug 2016 - General
 

An elder gentleman with backgroud of advanced alzheimer dementia, previous stroke, ischaemic heart disease, osteoarthritis, hypertension, (baseline very poor mobility needing assisatnce of 2 to mobilise, fully dependent on dailty activity, daughter is the main carer), was admitted to hospital due to markedly reduced in oral intake, dysuria, frequency of urine and incresed in confusion. Patient was diagnosed to have urinary tract infection and was treeated with 1 course of antibiotic. But, his oral intake remained very poor, and he appeared to be not interested in eating or drinking. He was not interested in taking the supplements drink given by dietician as well. The family members were very concern with regards to his oral intake, and was asking with regards the possibilty of inserting a feeding tube (PEG) for him for feedign purpose. What is your opinion??? Will you consider a PEG for him ??

This is a dedicated clinical scenario, as the insertion of a feeding tube (PEG) has its own risks as well to the patient. A balancing between the pros and cons, and considering or manging the family expectations are important. In general, in the cohort with advanced dementia, the reduction or minimal or none oral intake will signify poor prognosis of final stage of dementia (but need to rule out and treats other reversible cause like infection). Subjecting them to an invasive and potential risky...
 (Total 130 words)
I agree with Amit Parasnis. Life expectancy has to be considered with an elderly patient. There are multiple options to mull before PEG. One is increasing hydration through the intravenous route coupled with a nasogastric tube insertion. In our practice, NGT feeding is usually tried first if the patient is comfortable with having a tube inserted. If there is no improvement with feeding after a month, PEG has to b...
 (Total 107 words)
The situation needs to be discussed with the family. With such a poor perfromance status and multiple co-morbidities, the life expectancy of this patient is going to be less. If the family members accept the fact that the patient is going to have a very poor quality of life due to his multiple illnesses, then it would be prudent not to do any further intervention and try to support the patient with intravenous fluids and oral liquids whenever possible. If, however, the relatives insist on doing ...
 (Total 117 words)