“WOULD YOU DECIDE IN FAVOR OF A GASTROSTOMY TUBE IN PATIENTS WITH ADVANCED DEMENTIA?”. A CRITICAL REVIEW OF THE LITERATURE

Abstract

Overall, patients with dementia who are characterized by a progressive cognitive decline, are at “high risk” for dehydration, malnutrition and aspiration pneumonia. The management of feeding and swallowing disorders afflicting patients with dementia of the Alzheimer type in the middle and late stages of the disease, is critical while maintaining the minimum required nutrition poses a daily challenge for clinicians and other health professionals. For most of the 20th century, the provision of artificial enteral nutrition, especially percutaneous endoscopic gastrostomy (PEG), was considered a “solution” in combating the problems of feeding and swallowing in advanced dementia, while it was thought that it contributed to prolonging the life of these individuals. However, the benefits of its use in this population have not been proven.
The continuing controversy over the placement of food catheters in patients with dementia, highlights the need for understanding their advantages and disadvantages and for defining the term “quality of life” and how everyone involved sees it. It is deemed necessary to provide information and training to the medical staff and relatives to manage feeding and swallowing problems in patients with dementia in order to minimize the unnecessary placement of feeding tubes and their associated possible complications, improve patient care and reduce the extensive cost to the health system.