Dementia is a progressive neurodegenerative syndrome. The percutaneous endoscopic gastrostomy/jejunostomy (PEGJ) tube was first introduced in clinical practice in 1980 as a means to provide nutrition to children. PEGJs are often placed in elderly patients with advanced dementia who cannot swallow but have intact gut function for long‐term nutritional support. Data are lacking on survival of this population following PEGJ placement. We report the survival after PEGJ placement in elderly patients suffering from dementia at a large Midwestern hospital.
Medical records were reviewed of consecutive patients ≥ 65 years undergoing initial PEGJ insertion with a history of dementia during the period 2000 through 2007. Collected data included albumin level, hemoglobin, white blood cell count (WBC), sex, race and age of the patient. The Charleson comorbidity index (CCI) was calculated for each patient as a measure of chronic disease burden. Date of death was determined using medical records and the Social Security Death Index.
Five hundred and twelve cases were available for study, and 376 cases had complete information for multivariate analysis. Average age of the patients was 81.6 years (range, 65‐103 years), men compromised 46% and African Americans 76% of the population. The average albumin was 2.7 g/dL, hemoglobin 10.4 g/dL, and WBC 9.6 × 103/μL. Approximately 25% of patients died within 1 month, 50% died within 3 months, and 73% died within 12 months. Multivariate analysis using Cox proportional hazards regression found the following factors predictive of early death: age (P < 0.0001), high WBC (P = 0.009), low albumin (P = 0.014), CCI score (P = 0.017), and male sex (P = 0.040). Hemoglobin level and race were not independently associated with mortality in these patients. There was some evidence of improved survival over the duration of the study period (P = 0.05).
Patients with diagnosis of dementia have limited life expectancy even after PEGJ placement. Our cohort had decreased survival after PEGJ tube insertion compared with previous small studies. We found that older male patients with elevated WBC, low albumin, and multiple comorbidities in this population do particularly poorly. Careful assessment of coexisting conditions and clinical status of the patient should be done before considering placing PEGJ tubes in patients with advanced dementia.
A. Sekhri ‐ Henry Ford Health System, employment, none; G. Buran ‐ Henry Ford Health System, employment, none; J. Velasco‐ Henry Ford Health System, employment, none; G. Jacobsen ‐ Henry Ford Health System, employment, none; L. J. Bricker‐ Henry Ford Health System, employment, none; D. Debono ‐Henry Ford Health System, employment, none
To cite this abstract:Sekhri A, Buran G, Velasco J, Jacobsen G, Debono D. Survival of Elderly Patients with Dementia After Percutaneous Feeding Tube Placement. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 106. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/survival-of-elderly-patients-with-dementia-after-percutaneous-feeding-tube-placement/. Accessed March 28, 2020.