Survival in Older Adults with Dementia and Eating Problems

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Survival in Older Adults with Dementia and Eating Problems



A recent study explores the use of percutaneous endoscopic gastrostomy, or PEG, to provide long-term enteral nutrition in elderly dementia patients. This feeding option presents many challenges as well as ethical concerns in patients who have difficulty eating or routinely refuse food orally. Patients with dementia may experience decreased quality of life or injure themselves when prescribed a PEG tube.

This study followed 184 patients with dementia and malnutrition. After 18 months, mortality rates were measured. Data was compared in patients with enteral nutrition delivered via PEG versus oral nutrition. A total of 54 patients were prescribed enteral nutrition and it was found that survival rates were significantly lower compared to those prescribed oral nutrition. In fact, enteral nutrition was a significant predictor of death independent of age and stage of dementia. 

The researchers recommended that PEG usage should be highly discouraged in this population. As patients loose their ability to eat, and as a result become malnourished, it would seem necessary to provide an nutrition intervention such as enteral feeding. However, this poses a greater threat to the patient than malnutrition itself, perhaps. Here, the creativity of the dietitian is important in finding a solution to this patient's inability to reach caloric needs. Other studies have explored the use of music, finger foods, high calorie supplements, or changes in the dining environment during meal times to increase oral intake. Dietitians should be aware of these other factors they can manipulate that may reduce malnutrition in dementia patients in order to provide the best nutrition intervention possible. 




(AG)

Source:

Ticinesi A, et al., Survival in older adults with dementia and eating problems: To PEG or not to PEG?, Clinical Nutrition (2016), http://dx.doi.org/10.1016/j.clnu.2016.04.001

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