Are we using percutaneous endoscopic gastrostomy appropriately in the elderly?

Area of Science:

• Geriatric Medicine
• Gastroenterology
• Medical Ethics

Background:

• Percutaneous endoscopic gastrostomy (PEG) is increasingly used in elderly, frail patients.
• Outcomes are often poor, with significant 30-day mortality and functional decline.
• Many elderly individuals would decline tube feeding, particularly with advanced dementia.

Purpose of the Study:

• To review the case mix, outcomes, and ethical considerations of PEG feeding.
• To provide guidance on appropriate patient selection for PEG procedures.

Main Methods:

• Review of existing literature on PEG feeding in elderly and frail populations.
• Analysis of case mix, patient outcomes, and ethical dilemmas.
• Development of selection criteria for PEG.

Main Results:

• High rates of mortality and morbidity observed post-PEG in frail elderly patients.
• Discrepancy between increasing PEG use and patient/family wishes regarding artificial nutrition.
• Ethical challenges concerning beneficence, autonomy, and quality of life.

Conclusions:

• PEG feeding in very elderly and frail individuals is associated with suboptimal outcomes.
• There is a need for improved patient selection to ensure PEG aligns with patient wishes and provides genuine benefit.
• Ethical frameworks must guide decisions regarding PEG in end-of-life care and advanced dementia.