LONG-TERM FOLLOW-UP OF CONSEQUENCES OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) TUBES IN NURSING-HOME PATIENTS

PEG (percutaneous endoscopic gastrostomy) tubes are frequently placed in nursing home patients. The aim of this study was to assess retrospe ctively the long-term changes in functional and nutritional statuses, tube-related complications, and factors influencing survival in 46 nur sing home residents, mean age 73.6 years (range 19-96). Functional sta tus was evaluated by a standard rehabilitation medicine scale. Nutriti onal status was evaluated by serum albumin and cholesterol concentrati ons and by weight. PEG-related complications requiring hospitalization or emergency room or clinic evaluations were noted. Additionally, cha nges in resuscitation status were noted. The predominant indication fo r PEG placement was dementia (52%). At PEG placement, 48% of patients had total functional impairment Regardless of the severity of impairme nt, no patient's functional status improved after PEG. Nutritional sta tus did not improve significantly. Mortality approached 50% and 60% at 12 and 18 months, respectively, and was significantly related to age, resuscitation status, and serum albumin concentration. All patients u nder 40 years of age at PEG survived, in contrast to 41.3% of patients over 40 years of age CP < 0.001). Sixty-three percent of patients who were ''full code'' at PEG placement survived, in contrast to 10% of ' 'no code'' patients (P < 0.001). Albumin greater than or equal to 3.5g /dl at PEG or thereafter was associated with improved survival (P < 0. 001) as compared to albumin <3.5g/dl. PEG-related complications occurr ed in 34.7% of patients, and the first occurred four months after PEG. We conclude that realistic expectations of what PEG can accomplish be a factor in the decision to place a PEG tube in nursing home patients .