Artificial Feeding for Elderly Patients after Stroke

摘要

Geriatricians are often confronted by the problem of establishing and maintaining effective nutrition for frail patients, particularly those patients with dysphagia and a high risk of aspiration following stroke. Many opt for nasogastric tube (NGT) feeding as the long-term solution to the problem of dysphagia, whilst others use NGT feeding in the immediate and intermediate phases and consider percutaneous endoscopically placed gastrostomy (PEG) for long-term feeding. Recent articles in this journal by Raha and Woodhouse have drawn attention to the indications for PEG, emphasizing its safety and patient acceptability. In the present article, the authors wish to consider the issues of comparative tolerability, efficacy, associated morbidity and mortality, ease of insertion and removal of NGT and PEG feeding systems for elderly people, and the timing of artificial feeding modalities. PEG is still viewed by many as the last option when all other methods of feeding have failed. Should PEG feeding be used more widely? Should it be considered for use in the intermediate and perhaps even the immediate phases of dysphagia?