Evaluation of the benefits of gastric tube feeding in an elderly population
J. P. Weaver, P. Odell and C. Nelson
Central Carolina Cardiovascular and Thoracic Surgical Associates, Durham, NC.
OBJECTIVE: To assess the benefits of gastric tube feeding in an elderly
community hospital population. SUBJECTS: One hundred consecutive patients
who required feeding gastrostomies from July 1984 through June 1987.
SETTING: Durham (NC) Regional Hospital, a 380-bed community hospital.
METHODS: Patients were evaluated using a quality of life scale (QL scale)
adapted from Spitzer's QL Index. The evaluation was based on hospital
records at the time of tube placement and interviews with patients or
family members at follow-up between June 1991 and March 1992. Subjective
evaluation of the benefits of gastric tube feeding were obtained in
interviews with patients or their families at follow-up. RESULTS: Overall
there was no significant change in the objective evaluation of quality of
life at follow-up. Men, patients over 76 years of age, and patients with
chronic illnesses such as multiple strokes or dementia showed the poorest
response on the QL scale. Subjective evaluation by patients or their family
members was positively correlated with objective evaluation on the QL
scale. Family members of patients who showed the poorest response on the QL
scale were more likely than other family members to respond no to the
question, "Would you want this done to you if you were in his/her
situation?" CONCLUSIONS: Our QL scale provides a good indication of
patients' and family members' subjective evaluation of the benefits of
gastrostomy tube feeding after 4 to 8 years. Thus, the scale should be
helpful to physicians who must consult with patients and their families and
make decisions about the use of this procedure. The significant discrepancy
between family members' evaluations of the benefit of the procedure to the
patient and their refusal of the procedure for themselves if they were in
the patient's situation confirms the need for advance directives and the
importance of conscientious implementation of the Patient Self
Determination Act of 1990.
