Jaul et al. affirm that because tube feeding does not add to
patient pain or discomfort, it should not be contraindicated
when it complies with the values and wishes of patients and
their families (14).
Higaki et al (13) state that there is no evidence to support
a poorer prognosis after PEG in elderly people with dementia
compared with the cognitively preserved elderly, emphasizing
that survival after PEG was not significantly affected by the
presence of dementia. For these reasons, caution should be
taken in denying PEG based only in the presence of dementia.
This is supported by the findings of Gaines and co-workers (12)
who report that patients with dementia or significant cognitive
impairment do not have a significantly shorter survival after
PEG than patients with intact cognitive function.
Kumagai et al. (20) claim that nursing education
for caregivers and staff as well as maintenance of the care
environment in the area are necessary before introducing highquality
medical care.
Martins et al. (2) considered that there may be a subgroup
of patients with dementia that do not benefit from enteral
nutrition. They suggest that subsequent studies should focus
on determining the characteristics of this subgroup to avoid
complex and expensive therapies and adequately orient families
to avoid unrealistic expectations and unnecessary suffering