Association of nutritional support with survival-time in hospitalized older patients with dysphagia: a retrospective study.

Dysphagia results from age-related changes in swallowing physiology and contributes to various health status changes, including higher risks for malnutrition, pneumonia, and mortality [1, 2]. It also occurs in age-related diseases, including stroke [3] and cancer [4], and progressive neurological diseases, such as dementia [5] and Parkinson's disease [6]. These associations, and global aging, have increased the importance of dysphagia management. Artificial nutrition can support patients with dysphagia caused by various clinical conditions. Percutaneous endoscopic gastrostomy (PEG) is an artificial nutrition method that secures an enteral nutrition (EN) route in dysphagia patients [7]. PEG tubes have been widely used in Japan as a convenient and effective EN route since approximately 1990; however, the use of PEG feeding in dementia patients is controversial [8-10]. Total parenteral nutrition (TPN) is an alternative nutritional management method [11] and has been the most frequently used nutritional support method in Japan since 2010. A comparison of long-term outcomes associated with PEG feeding and TPN in older patients found that older patients, and those with poorer nutritional status and severe dementia, were more likely to receive TPN, whereas patients with cerebrovascular disease were more likely to receive PEG [12]. A 2012 Japan Geriatric Society position statement on end-of-life care for older adults suggested that patients' families or caregivers should decide whether feeding tubes should be withheld or withdrawn [13]. Although advanced directives are now widely used, the decision of whether to institute enteral tube feeding is an important issue for older patients and their families. However, global clinical evidence for the effect of artificial nutritional support on survival-time, and for differences between administration routes, is lacking. The rate of aging in Japan is more rapid than in any other country, and more research is needed on clinical decision making for the older population. The study aim was to clarify the effects of artificial nutritional support route on survival-time of older terminal patients with dysphagia.