Abstract
A variety of diseases often lead to impaired swallowing abilities in the elderly. Indications for selecting individuals for percutaneous endoscopic gastrostomy (PEG) remain unclear. The aim of this study was to investigate the validity of PEG placement in elderly patients performed at a local community hospital in Japan. The medical records of 481 consecutive patients aged 65 and older who underwent PEG were retrospectively reviewed. Cerebrovascular diseases were found to be the most common among the underlying diseases (48.2%). The majority of patients were unable to consent on their own to PEG placement. Among 220 individuals who died after PEG placement (median 7 months), the 1-year survival rate was 60.1%. PEG placement in elderly patients with dementia in an end-of-life care setting who cannot consent to PEG might be decided without actual benefit to such patients. A debate over indications for and issues of human dignity related to this procedure needs to be immediately initiated throughout the entire nation. There are several limitations to this study. This was a single center and case-series study. However, it is difficult to conduct a randomized controlled study in this field. Despite these limitations, we have to initiate an argument in order to arrive at a reasonable agreement regarding this issue.
