1. Clinical Implications
The Effects of Percutaneous Endoscopic Gastrostomy Placements on Mortality in Patients with Advanced Dementia Diagnoses
E. Brooke Thevenin, B.S., and Kelly Rutherford M.S., CCC-SLP
Alzheimer’s disease diagnoses will be present in the deaths of an estimated 700,000 elderly Americans this year (Alzheimer’s Association, 2015). Projected mortality rates encourage the discussion of life-prolonging measures such as enteral nutrition placements in medical settings. Recent studies have discussed the life-prolonging benefits of enteral nutrition, but individualized patient care practices have left professionals questioning significant success rates for different diagnoses. Cognitive function, accompanied by a diagnosis of advancing dementia, could be predictive of a client’s mortality rate and placement success rates in relation to life-prolongation.
The purpose of this study is to conduct a literary analysis of studies examining mortality rates of patients with dementia using percutaneous endoscopic gastrostomy feeding placements to develop an understanding of identified predictors and the related impacts on patient mortality. When considering the literature, inclusionary criterion were set as follows: publication date within the past 15 years to ensure relevance to current patient practice, investigation of mortality rates of dementia patients, formal dementia diagnoses for population samples in each study, and use of percutaneous endoscopic gastrostomy tubes as the enteral nutrition method to allow for accurate comparisons of placement-related outcomes. Four research studies met the established inclusionary criterion.
Introduction
Methods
Jaul, Levin, and Menczel (2014) completed a retrospective chart analysis of 149 participants, 99 of which were tube fed. Throughout this study, survival calculations for participants were calculated based upon presence of pressure ulcers, low hemoglobin levels, and low body mass index levels (Jaul, Levin, & Menczel, 2014). It was discovered that median survival time for tube fed patients with the aforementioned risk factors was higher, but not significant in comparison to orally fed patients (Jaul, Levin, & Menczel, 2014).
The presence of dementia diagnoses weakens correlations between various predictive factors and patient survival (Shah, Sen, Perlmuter, & Feller, 2005). Several variables related to subject demographics were investigated in regards to mortality rates for patients with dementia, one constantly recurring factor being age. Sanders et al. (2000) suggested that age and population group were considered separate predictive factors of patient mortality. Jaul, Levin, and Menczel (2014) also found that subject age was not a significantly differing factor between orally fed and tube fed patients, indicating that differences in mortality outcomes could not be contributed to patient age solely. These findings suggest that, regardless of age, degree of dementia and the presence of formal diagnoses holds influence over mortality rates in percutaneous endoscopic gastrostomy patients.
Results
The recommended use of percutaneous endoscopic gastrostomy placements in dementia patients is still noted around the world despite the research findings concerning mortality rates. Professional education for those who treat patients with dementia and feeding/ swallowing complications may reduce the use of these placements in the dementia population. Further training regarding alternative treatment options and the employment of counseling tools could lead professionals to consider more individualized patient care in relation to quality versus quantity of life. Each of these aspects of continuing education may be beneficial in addressing clients and caregivers who believe enteral nutrition methods are effective.
The speech-language pathologist is the professional evaluating patients, diagnosing swallowing complications, and, eventually, making recommendations for each patient. Consideration of the various relationships for each client are necessary and will influence the delivery of client-based information and updates, but it should never affect the content of the message. Caregivers have a right to an educated decision based on knowledge of all treatment options. As a member of a dementia patient’s collaborative medical team, speech-language pathologists are also responsible for these counseling and client/caregiver education aspects. The use of research, quality of life considerations, and explanations of all options are necessary for all recommendations related to dementia patient care.
Clinical Implications
Professional
Roles
Disclosures: E. Brooke Thevenin and Kelly Rutherford have no financial or non-financial relationships to disclose.
Special Thanks: The authors would like to give special thanks to the Department of Communication Disorders faculty for their mentorship and support throughout our research endeavors.
2015 Annual Convention of the American Speech-Language Hearing Association, Denver CO
Session 8748 / Poster 554
References:
Please refer to the handout provided for an all-inclusive list of the resources utilized within this research study.