Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting

Christopher Callahan, Kathy M. Haag, Morris Weinberger, William M. Tierney, Nancy N. Buchanan, Timothy E. Stump, Rod Nisi

Research output: Contribution to journalArticle

180 Citations (Scopus)

Abstract

OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) has become the preferred method to provide enteral tube feeding to older adults who have difficulty eating, but the impact of PEG on patient outcomes is poorly understood. The objective of this study was to describe changes in nutrition, functional status, and health-related quality of life among older adults receiving PEG. DESIGN: A prospective cohort study. SETTING: A small community of approximately 60,000 residents served by two hospital systems. PARTICIPANTS: One hundred fifty patients aged 60 and older receiving PEG from one of the four gastroenterologists practicing in the targeted community. MEASUREMENTS: Patients were assessed at baseline and every 2 months for 1 year to obtain clinical characteristics, process of care data, physical and cognitive function, subjective health status, nutritional status, complications, and mortality. RESULTS: Over a 14-month period, 150 patients received PEG tubes in the targeted community; the mean age was 78.9. The most frequent indications for the PEG were stroke (40.7%), neurodegenerative disorders (34.7%), and cancer (13.3%). All measures of functional status, cognitive status, severity of illness, comorbidity, and quality of life demonstrated profound and life-threatening impairment; 30-day mortality was 22% and 1-year mortality was 50%. Among patients surviving 60 days or more, at least 70% had no significant improvement in functional, nutritional, or subjective health status. Serious complications were rare, but most patients experienced symptomatic problems that they attributed to the enteral tube feeding. CONCLUSIONS: PEG tube feeding in severely and chronically ill older adults can be accomplished safely. However, there are important patient burdens associated with the PEG and there was limited evidence that the procedure improves functional, nutritional, or subjective health status in this cohort of older adults. The issues raised in this descriptive study provide impetus for a randomized trial of PEG tube feeding compared with alternative methods of patient care for older adults with difficulty eating.

Original languageEnglish
Pages (from-to)1048-1054
Number of pages7
JournalJournal of the American Geriatrics Society
Volume48
Issue number9
StatePublished - 2000

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Gastrostomy
Enteral Nutrition
Diagnostic Self Evaluation
Health Status
Nutritional Status
Mortality
Eating
Quality of Life
Neurodegenerative Diseases
Cognition
Comorbidity
Patient Care
Chronic Disease
Cohort Studies
Stroke
Prospective Studies

Keywords

  • Aged
  • Enteral tube feeding
  • Health status
  • Nutrition

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Callahan, C., Haag, K. M., Weinberger, M., Tierney, W. M., Buchanan, N. N., Stump, T. E., & Nisi, R. (2000). Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting. Journal of the American Geriatrics Society, 48(9), 1048-1054.

Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting. / Callahan, Christopher; Haag, Kathy M.; Weinberger, Morris; Tierney, William M.; Buchanan, Nancy N.; Stump, Timothy E.; Nisi, Rod.

In: Journal of the American Geriatrics Society, Vol. 48, No. 9, 2000, p. 1048-1054.

Research output: Contribution to journalArticle

Callahan, C, Haag, KM, Weinberger, M, Tierney, WM, Buchanan, NN, Stump, TE & Nisi, R 2000, 'Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting', Journal of the American Geriatrics Society, vol. 48, no. 9, pp. 1048-1054.
Callahan, Christopher ; Haag, Kathy M. ; Weinberger, Morris ; Tierney, William M. ; Buchanan, Nancy N. ; Stump, Timothy E. ; Nisi, Rod. / Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting. In: Journal of the American Geriatrics Society. 2000 ; Vol. 48, No. 9. pp. 1048-1054.
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abstract = "OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) has become the preferred method to provide enteral tube feeding to older adults who have difficulty eating, but the impact of PEG on patient outcomes is poorly understood. The objective of this study was to describe changes in nutrition, functional status, and health-related quality of life among older adults receiving PEG. DESIGN: A prospective cohort study. SETTING: A small community of approximately 60,000 residents served by two hospital systems. PARTICIPANTS: One hundred fifty patients aged 60 and older receiving PEG from one of the four gastroenterologists practicing in the targeted community. MEASUREMENTS: Patients were assessed at baseline and every 2 months for 1 year to obtain clinical characteristics, process of care data, physical and cognitive function, subjective health status, nutritional status, complications, and mortality. RESULTS: Over a 14-month period, 150 patients received PEG tubes in the targeted community; the mean age was 78.9. The most frequent indications for the PEG were stroke (40.7{\%}), neurodegenerative disorders (34.7{\%}), and cancer (13.3{\%}). All measures of functional status, cognitive status, severity of illness, comorbidity, and quality of life demonstrated profound and life-threatening impairment; 30-day mortality was 22{\%} and 1-year mortality was 50{\%}. Among patients surviving 60 days or more, at least 70{\%} had no significant improvement in functional, nutritional, or subjective health status. Serious complications were rare, but most patients experienced symptomatic problems that they attributed to the enteral tube feeding. CONCLUSIONS: PEG tube feeding in severely and chronically ill older adults can be accomplished safely. However, there are important patient burdens associated with the PEG and there was limited evidence that the procedure improves functional, nutritional, or subjective health status in this cohort of older adults. The issues raised in this descriptive study provide impetus for a randomized trial of PEG tube feeding compared with alternative methods of patient care for older adults with difficulty eating.",
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AU - Stump, Timothy E.

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N2 - OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) has become the preferred method to provide enteral tube feeding to older adults who have difficulty eating, but the impact of PEG on patient outcomes is poorly understood. The objective of this study was to describe changes in nutrition, functional status, and health-related quality of life among older adults receiving PEG. DESIGN: A prospective cohort study. SETTING: A small community of approximately 60,000 residents served by two hospital systems. PARTICIPANTS: One hundred fifty patients aged 60 and older receiving PEG from one of the four gastroenterologists practicing in the targeted community. MEASUREMENTS: Patients were assessed at baseline and every 2 months for 1 year to obtain clinical characteristics, process of care data, physical and cognitive function, subjective health status, nutritional status, complications, and mortality. RESULTS: Over a 14-month period, 150 patients received PEG tubes in the targeted community; the mean age was 78.9. The most frequent indications for the PEG were stroke (40.7%), neurodegenerative disorders (34.7%), and cancer (13.3%). All measures of functional status, cognitive status, severity of illness, comorbidity, and quality of life demonstrated profound and life-threatening impairment; 30-day mortality was 22% and 1-year mortality was 50%. Among patients surviving 60 days or more, at least 70% had no significant improvement in functional, nutritional, or subjective health status. Serious complications were rare, but most patients experienced symptomatic problems that they attributed to the enteral tube feeding. CONCLUSIONS: PEG tube feeding in severely and chronically ill older adults can be accomplished safely. However, there are important patient burdens associated with the PEG and there was limited evidence that the procedure improves functional, nutritional, or subjective health status in this cohort of older adults. The issues raised in this descriptive study provide impetus for a randomized trial of PEG tube feeding compared with alternative methods of patient care for older adults with difficulty eating.

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