Abstract
Gastrostomy tube feeding is used to maintain or improve nutritional status in older patients with severe dysphagia and/or severe malnutrition due to different diseases. This paper explores the use of gastrostomies within geriatric care in three European countries to better understand the problems underlying variability in its use.
Large differences are described in the rates of use of gastrostomies between countries and inside each country, but its incidence has been steadily growing in recent years, apparently peaking in Germany due to better adherence to guidelines. In geriatric care, the most frequent indications for gastrostomies are advanced neurodegenerative diseases.
Decision on placing a gastrostomy is not consistent, with different specialists concerned and different decision-making processes. Specialists in geriatric care and nutrition are not always involved, even in complex older patients.
The pull endoscopic technique is the preferred method to place gastrostomies, either ambulatory or with a short hospital stay; other insertion techniques are used occasionally. Both gastrostomy insertion and tube feeding are mostly paid by the national health system of each country.
The goal of tube feeding is to cover the individual's nutritional needs but, in the context of geriatric medicine, the potential of tube feeding for improving function, quality of life or survival is also considered before a gastrostomy is chosen. Many ethical and cultural issues are involved in tube feeding, and attitudes of patients and caregivers seem to be quite different in different countries and settings.