A retrospective study of outcome of percutaneous endoscopic gastrostomy in older adults with advanced cognitive impairment and severely reduced activities of daily living

Aim: To investigate the outcome of percutaneous endoscopic gastrostomy (PEG) in elderly patients with swallowing difficulties who required high-level nursing care. Methods: We extracted the data of 57 patients (24 men and 33 women) who were admitted to our hospital with a diagnosis of pneumonia over a 5-year study period between January 2006 and December 2010. Evaluation included activities of daily living (ADL), nursing care level (NCL) based on assessment of care requirement, pre-existing disease, blood test data, swallowing function before PEG, and outcome. Results: The mean age of the patients was 84.7±8.3 years old. The mean total functional independence measure (FIM) score was 29.7±16.2 and the median NCL value was 4. The most frequently observed pre-existing diseases were degenerative central nervous system disorders including Alzheimer's disease and cerebrovascular disease, which occurred in approximately 80% of participants. A low serum albumin value and high c-reactive protein (CRP) level were also often observed, suggesting chronic inflammatory conditions. For swallowing function, the median value according to the Fujishima swallowing grading system was 5, and aspiration and pharyngeal residues were observed on videofluoroscopic examination of swallowing (VF) (82.5% and 100% of all cases, respectively). The median survival time after PEG was 451.0±79.7 days, with a one-year survival rate of approximately 56%. A total of 51 patients (89.5%) died after PEG and the mean duration from the PEG to death was 518.5±471.7 days. Of these 51, 45 (88.2%) died of pneumonia. Conclusions: In patients with advanced cognitive impairment and severely reduced ADL, there appears to be little benefit on ADL and the prevention of pneumonia by PEG, and most outcomes following PEG were not favorable in the current results.