Responses of the elderly with dementia to suggestion of gastrostomy

Kazuhiro Niizato¹⁾, Gen Ohi2)

¹⁾Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital
²⁾Professor Emeritus of the University of Tokyo

More than 560,000 patients in Japan are currently placed with percutaneous endoscopic gastroscopy (PEG), a controversial treatment for the elderly with advanced dementia. As their preference for PEG installment seems routinely ignored, we asked 70 demented elderly (29 males, 41 females;37 Alzheimer's Disease, 11 vascular dementia, 22 other types;MMSE 17.7 points;HDS-R 14.3 points) if they would have gastrostomy installed as a life-prolonging measure. Eighty % promptly rejected the idea with frequent shows of disgust and the remaining 20% were unable to answer. None responded affirmatively. Their instant and emotional rejections may represent activation of a prior emotional experience in comparable situations. We believe that asking the intent of the demented elderly regarding initiating gastrostomy is an ethically valid and practical precaution to avert the controversial issue.

Address correspondence to Dr. Kazuhiro Niizato, Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital (2-1-1 Kamikitazawa, Setagaya-ku, Tokyo 156-0057, Japan)