Long-term effects of gastrostomy in elderly patients as observed by nurses

1.目的和方法本研究的目的是从护士的角度探讨胃造瘘术对老年患者的影响。方法：1.对护士进行访谈，并对来访护士进行问卷调查。访谈调查结果1)胃造口术除吸入和营养不良外，还因社会因素，如出院和入院。2)胃造口术最有益的作用是恢复口腔摄入。3)护士报告，在发生严重术后并发症的情况下，很难阐明胃造口术对患者的益处，在胃造口术后根据患者家属的意愿进行胃造口术的患者，以及在胃造口术后家属不再探视的患者。问卷调查结果1)在422名访问护士中，151名(35.8%)曾照顾过一位有胃造口史的老人，且在过去一年内死亡。3)死亡前一年观察到的常见体征包括吞咽困难、痰增多和瘘口皮肤问题，而死亡前一周观察到的体征包括便秘、发热、水肿、压疮、痉挛和痰增多。护士观察到的主要效果是口腔摄取的恢复。然而，直到死亡前一年，吸入和肺炎的风险再次增加。这些发现表明有必要研究在终末期胃造口术的使用。

1. Objective and methodsThe objective of the present study was to elucidate the effects of gastrostomy on elderly patients from the perspective of nurses. An interview on nurses and a questionnaire survey on visiting nurses were conducted.2. Results of the interview survey1) Gastrostomy was performed due to social factors such as discharge and admission to facilities in addition to aspiration and malnutrition.2) The most beneficial effect of gastrostomy was the recovery of oral ingestion.3) Nurses reported that it was difficult to elucidate benefits of gastrostomy to patients in cases where serious postoperative complications occurred, cases where gastrostomy was performed according to the wishes of the family over those of the patient, and cases in which the family no longer paid visits following gastrostomy.3. Results of the questionnaire survey1) Among the 422 visiting nurses surveyed, 151 (35.8%) had provided care for an elderly with a history of gastrostomy who had died within the past year.2) A total of 65.5% of the deceased elderly had already received gastrostomy by the start of visiting nursing. In addition, 35.8% of patients died〓3 years after gastrostomy.3) Common physical signs observed one year before death included dysphagia, increased sputum, and skin problems at the fistula site, while those observed one week before death included constipation, fever, edema, bedsores, contracture, and increased sputum.4. SummaryThe main effect observed by nurses was the recovery of oral ingestion. However, the risks of aspiration and pneumonia increased again up to one year before death. These findings indicate the need to investigate the use of gastrostomy during the terminal phase.