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ASSOCIATION BETWEEN FEEDING VIA PERCUTANEOUS ENDOSCOPIC GASTROSTOMY AND LOW LEVEL OF CAREGIVER BURDEN

2007; Wiley; Volume: 55; Issue: 9 Linguagem: Inglês

10.1111/j.1532-5415.2007.01276.x

1532-5415

Hiromi Enoki, Yoshihisa Hirakawa, Yuichiro Masuda, Mitsunaga Iwata, Jun Hasegawa, Sachiko Izawa, Akihisa Iguchi, Masafumi Kuzuya,

Enhanced Recovery After Surgery

To the Editor: Percutaneous endoscopic gastrostomy (PEG) has become the preferred method of providing enteral tube feeding to older people who have difficulty eating.1 Although a number of studies have been conducted to evaluate the effects of long-term nutritional support via a PEG tube on the outcomes of the patients, including mortality and morbidity, the outcomes of PEG placement from a caregivers' perspective has received little attention. Over the years, research on family caregivers has consistently demonstrated that greater caregiver burden relates to poorer mental and physical health,2, 3 but little attention has been paid to the effect that providing care to a family member with PEG placement has on caregivers. This study assessed the caregiver burden of patients who underwent PEG tube placement and compared it with that of those who feed via other nutritional routes. The present study consisted of a cross-sectional analysis of the baseline data of a subgroup of participants in the Nagoya Longitudinal Study of Frail Elderly.4, 5 The study population consisted of 1,196 caregivers (mean age±standard deviation 63.9±12.3, 75.7% female, 43.7% spouse, 33.2% adult child, 20.2% daughter-in-law, 3.0% other) and matched care recipients who were community-dwelling older people (aged 80.8±8.2, 63.4% female) and were provided various home care services under the long-term care insurance (LTCI) program. The data included clients' demographic characteristics, a rating for 10 activities of daily living (range 0–20, mean score 11.4±6.7), a rating for instrumental activities of daily living (IADLs, range 0–8, mean score 2.5±2.4), and the Charlson Comorbidity Index (mean score 2.1±1.6). Severity of dementia was evaluated according to the criteria provided by the public LTCI policy, which are classified into five levels (42.0% had at least some cognitive impairment).6 The routes of nutrition and types of diet were classified into five categories: oral intake (1, solid regular-texture diet; 2, modified-texture diet (a minced or pureed texture); 3, nasogastric tube feeding; 4, PEG tube feeding; and 5, oral intake with enteral nutrition). Data were also obtained from caregivers concerning their own personal demographic characteristics, and their subjective burden as assessed using the Japanese version of the Zarit Burden Interview (ZBI, mean score 28.8±17.0).7 One-way analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were used to compare caregiver burden according to the groups of nutrition routes and types of diet. Covariates of ANCOVA included relationship to the care recipient, IADL score, and cognitive levels. ANOVA with a Bonferroni correction for multiple comparisons was used to determine the difference in ZBI scores between groups. Table 1 provides a comparison of ZBI scores between groups. In the crude model (ANOVA), there were significant differences in ZBI score between a solid regular-texture diet and a modified-texture diet (P<.05), but no differences were observed between the other groups. In the adjusted model (ANCOVA), of the five groups, the lowest ZBI score was observed in caregivers with PEG use, and there were significant differences in ZBI score between the PEG group and the oral intake groups (solid regular-texture diet, P<.01; modified-texture diet, P<.01). The present study demonstrated that receiving enteral nutrients via PEG is associated with the lowest level of caregiver burden after adjusting for covariates and that a higher burden is observed for caregivers of participants who receive oral feedings. The participants in the present study were older people living in the community with functional disabilities. Therefore, even if they were receiving oral feedings, many caregivers seem to be engaged in feeding them. It is assumed that oral feeding for disabled elderly people is often difficult, time-consuming, and demanding for caregivers. It has been demonstrated that eating difficulties in older patients lead to a considerable burden for caregivers.8 PEG placement may reduce the time required for assisted feeding, although our results do not encourage PEG placement for elderly people only because of the association between PEG use and the low levels of caregiver burden. Even when caregiver time is limited, it is unacceptable to initiate tube feeding via PEG merely to facilitate care or reduce care burden. Efforts to enhance oral feeding by altering the environment and creating patient-centered approaches to feeding should be part of routine care for patients with difficulty eating. Nevertheless, the association between feeding via PEG and a low level of caregiver burden is another consideration in decision-making for long-term enteral feeding in older adults. Financial Disclosure: This study was supported by a Grant-in-Aid for Comprehensive Research on Aging and Health from the Ministry of Health, Labor, and Welfare of Japan, and a grant from Mitsui Sumitomo Insurance Welfare Foundation. Author Contributions: Hiromi Enoki: analysis and interpretation of data and preparation of manuscript. Yoshihisa Hirakawa, Yuichiro Masuda, and Mitsunaga Iwata: conduct of study and interpretation of data. Sachiko Izawa: statistical analysis and interpretation of data. Jun Hasegawa: acquisition of data. Akihisa Iguchi: study supervision. Masafumi Kuzuya: study concept and design, conduct of study, interpretation of data, and study supervision. Sponsor's Role: The sponsor had no role in the design, methods, subject recruitment, data collection, analysis, or letter preparation.