Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting
Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting
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DOI：
10.1111/j.1532-5415.2000.tb04779.x
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发表时间：
2000-09-01
影响因子：
6.3
通讯作者：
Nisi, R
中科院分区：
文献类型：
--
作者：
Callahan, CM;Haag, KM;Nisi, R
目的：经皮内镜胃造口术（PEG）已成为为进食困难的老年人提供肠内管饲的首选方法，但PEG对患者结局的影响尚不清楚。本研究的目的是描述接受PEG治疗的老年人的营养、功能状态和健康相关生活质量的变化。设计：一项前瞻性队列研究。设置：一个由两个医院系统服务的约60，000名居民的小社区。参与者：150名60岁及以上的患者接受了来自目标社区四位胃肠病学家之一的PEG治疗。患者进行了评估，在基线和每2个月为1年，以获得临床特征，护理数据，身体和认知功能，主观健康状况，营养状况，并发症和mortality.RESULTS：在14个月的时间内，150例患者接受PEG管在目标社区，平均年龄为78.9。PEG最常见的适应症为卒中（40.7%）、神经退行性疾病（34.7%）和癌症（13.3%）。所有功能状态、认知状态、疾病严重程度、合并症和生活质量指标均显示严重且危及生命的损害; 30天死亡率为22%，1年死亡率为50%。在存活60天或以上的患者中，至少70%的患者在功能、营养或主观健康状况方面没有显著改善。严重的并发症是罕见的，但大多数患者都经历了症状的问题，他们归因于肠内管feeding.CONCLUSIONS：PEG管喂养在严重和慢性疾病的老年人可以安全地完成。然而，PEG有重要的患者负担，并且有有限的证据表明该手术改善了该老年人队列的功能、营养或主观健康状况。本描述性研究中提出的问题为PEG管饲与进食困难的老年人患者护理的替代方法相比的随机试验提供了动力。
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.