Abstract
Undernutrition in frail elderly people is a pathological condition that needs to be recognized and addressed early. Neurological dysphagia is among the most frequent causes of this condition in the elderly but should be considered a terminal event in Alzheimer-type dementias. Tube feeding is an important resource for facilitating metabolic recovery in cachectic patients and is particularly successful in “bridging” and stabilizing therapies prior to major treatment able to cure the patient. Clinical management of tube feeding in “incurable” conditions is complex and becomes part of the palliative care and comfort provided in the terminal stages of illness. Non-specialized physicians are often unfamiliar with the theory and practice of end-of-life interventions, and the resulting decisions are in many cases actually contrary to patient comfort. These problems deserve to be more carefully addressed when the patient is unable to cooperate or express his/her preferences and needs. The success of percutaneous endoscopic gastrostomy has led to increasingly frequent referrals for placement in critically ill elderly patients. Endoscopists therefore become a key figure in stimulating rational, correct treatment of these patients.
Highlights
Endoscopists will probably play an increasingly key role given the growing elderly population admitted to endoscopy [10, 11]
An interesting study by Wolfson reported that life expectancy in a sample of 821 patients affected by dementia, the majority of them women with Alzheimer’s, was 3.3 years from time of onset
By way of a summary, the following directives can be drawn from the analysed guidelines: (i) percutaneous endoscopic gastrostomy (PEG) placement is recommended for patients who can benefit from it for at least 30 days; (ii) PEG should not be included in management plans for patients with Alzheimer’s disease; (iii) PEG placement should not be offered in the absence of proven benefit; (iv) where there are any doubts about assisted feeding, placement of a nasogastric tube can be considered for a limited trial period; (v) PEG placement cannot be programmed for unstable patients; (vi) artificial nutrition is not recommended in patients with end-stage dementia
Summary
Endoscopists will probably play an increasingly key role given the growing elderly population admitted to endoscopy (resulting in all specialist services and wards being overcrowded by older adults) [10, 11]. By way of a summary, the following directives can be drawn from the analysed guidelines: (i) PEG placement is recommended for patients who can benefit from it for at least 30 days; (ii) PEG should not be included in management plans for patients with Alzheimer’s disease; (iii) PEG placement should not be offered in the absence of proven benefit; (iv) where there are any doubts about assisted feeding, placement of a nasogastric tube can be considered for a limited trial period; (v) PEG placement cannot be programmed for unstable patients; (vi) artificial nutrition is not recommended in patients with end-stage dementia.
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