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American Journal of Alzheimer's Disease and Other Dementias®
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Percutaneous endoscopic gastrostomy in cognitively impaired older adults: A geropsychiatric perspective

Mark B. Detweiler, MD, MS

Kye Y. Kim, MD

Salem Veterans Affairs Medical Center, Edward Via Virginia College of Osteopathic Medicine and University of Virginia, Virginia

Jill Bass, MS, RN, CS

Carilion Center for Healthy Aging, Roanoke, Virginia

The increasing use ofpercutaneous endoscopic gastrostomy (PEG) in cognitively compromised elderly presents complex treatment-related and ethical questions. Approximately half of all dementia patients will be unable to feed themselves within eightyears of their diagnosis. Moreover, 85 percent of dementia patients have demonstrated refusal to eat. Geropsychiatry is often employed to evaluate these cognitively impaired patients either prior to or following PEG tube placement. This manuscript presents three cases to illustrate the most commonly encountered general dementia presentations. the ability to communicate with decisional capacity, the ability to communicate without decisional capacity, and severe verbal aphasia without decisional capacity. The study discusses ethical issues and treatment strategies for preand post-PEG tube placement consultations, including environmental interventions, in order to improve quality of life for this population.

Key Words: percutaneous endoscopic gastrostomy • geropsychiatry • dementia • tube feeding

American Journal of Alzheimer's Disease and Other Dementias®, Vol. 19, No. 1, 24-30 (2004)
DOI: 10.1177/153331750401900105
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