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Q: Gastrostomy tubes in frail elderly ( Answered 5 out of 5 stars,   0 Comments )
Subject: Gastrostomy tubes in frail elderly
Category: Health
Asked by: rosalima-ga
List Price: $50.00
Posted: 02 Jun 2003 09:14 PDT
Expires: 02 Jul 2003 09:14 PDT
Question ID: 211975
I need to know the dangers, side effects etc of using gastrostomy
tubes (g-tubes) in the frail elderly in nursing homes
Subject: Re: Gastrostomy tubes in frail elderly
Answered By: websearcher-ga on 02 Jun 2003 09:57 PDT
Rated:5 out of 5 stars
Hi rosalima:

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***procedure without first consulting with trained medical

Thank you for the interesting question.

Apparently, there are many risks associated with using gastrostomy
tubes, particularly in the elderly. I have found the following
excellent sites which go into the risks and dangers in some detail. I
have extracted key quotes from each site, but you might want to read
the entire articles to get a fuller understanding.

A Gastrostomy in Every Stomach?
"Yet for those with advanced age gastrostomies have serious risks,
risks that might not be fully known by those who recommend it or those
who accept its use. Ciocon et al showed that as many as 44 percent of
patients provided gastrostomy tubes developed agitation leading to
extubation. Often this response initiates a cascade of disasters
whereby the patient is restrained, either physically or chemically,
which increases the risk for iatrogenic complications. Gastrostomies
are often provided to prevent pneumonia in cases where there is the
threat of aspiration. Yet many studies have documented a rate of
aspiration pneumonia after gastrostomy tube placement that ranges from
8 to 56 percent."
"Another risk to the placement of gastrostomy tubes in older adults
with serious neurologic diseases is that it will become the standard
of care. In a study by Golden et al, the average age of the 102
nursing home residents who received a PEG tube was 89.3 years.
Eighty-seven percent had severe dementia (clinical dementia rating
scale, grade 3). Seventy-five percent were totally dependent in all
activities of daily living. As stated by Pick et al"

The Percutaneous Endoscopic Gastrostomy Tube:
Medical and Ethical Issues in Placement - ISSUES FOR GERIATRIC
"The majority of patients fail to achieve any meaningful improvement
in nutritional status, functional status, or subjective health status
after PEG placement. Grant and Rudberg demonstrated a 30-day mortality
of 23.9% in this population group. Rabenek had similar findings of
23.5% (18.9% for patients less than 65, 24.7% for patients 65–74, and
27.5% for patients greater than 75) for in-hospital mortality in a
Veterans Affairs study."
"There is no proven long-term benefit in weight gain or markers of
nutrition (albumin, prealbumin) when these patients are compared with
age-matched controls."

Tube Feeding in the Demented Elderly: A Review of the Evidence
URL: ://
"Also affecting the balance between hand feeding and tube feeding is
the immediate risk at the time of tube placement. Although the
procedure of tube placement is relatively safe, the patients are often
extremely vulnerable. Death rates during the procedure are commonly
cited as being between 0% and 2%. In a report of 882 nasogastric tube
insertions done under fluoroscopy, 3 patients died of arrhythmia."
"Summaries of available data tend to show that in fact tube feeding
may increase the risk of aspiration pneumonia. To date, no published
trial has suggested that risk is reduced though use of tube feeding.
Further support for the hypothesis that tube feeding may indeed be
ineffective comes from the observation that jejunostomy feeding also
does not appear to reduce the risk of pneumonia. If a patient is
unable to protect his airway during mealtimes, he will also be at risk
of aspiration and pneumonia between meals, regardless of how nutrition
is delivered."

Of course, there are other risks that occur regardless of the age of
the patient:

Gastrostomy/PEG Tube Placement
"What are the risks associated with gastrostomy tube placement?
The risks of this procedure include general anesthesia or sedation.
Patients may need to have their tube changed periodically. The area
around the tube may become infected after the operation. Infection or
bleeding within the abdomen may occur. Internal organs other than the
stomach can be injured during tube placement and require surgical
correction. Your surgeon should discuss the risks of the procedure and
how they apply to a specific patient’s situation."

"Tube Feeding" -- Right or Wrong: The Medical, Legal and Ethical
"Medical Complications of PEGs
The complications occurring with PEG placement can be divided into
minor and major categories (see Table 1). Most complications are minor
and occur in approximately 5-10% of cases. Usually, these consist of
easily treatable and uncomplicated wound infections, bleeding or
abdominal pain.
PEGs can become clogged. Accidental or deliberate removal of the tube
by the patient is another common complication. Patients may require
restraints in order prevent them from pulling on the tube.
Major complications are rare, occurring in only 1-2% of cases. The
overall mortality rate of PEG procedures is 0.3-1%. The risk of death
increases markedly with age.
Infection is a rare, though a potentially serious complication. Even
rarer complications are severe bleeding and intestinal obstruction."
Note: Make sure you go to the article to see the mentioned table!

This is probably enough reading for you to start with. If you need
some further detail after you have read through the above, please use
the Clarification Request feature to provide me with more details of
what you are interested in in particular.

Hope this helps with your research!


Search Strategy (on Google):

"gastrostomy tubes" risks
elderly OR older gastrostomy tubes risks OR dangers "gastrostomy
tubes" risks

Clarification of Answer by websearcher-ga on 02 Jun 2003 09:59 PDT
Hi rosalima:

The search strategies should read:

"gastrostomy tubes" risks 
elderly OR older gastrostomy tubes risks OR dangers 

rosalima-ga rated this answer:5 out of 5 stars

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