Gastrostomia em pacientes com demência: uma revisão integrativa da literatura

Abstract

Population aging has been advancing rapidly. In Brazil, between 2010 and 2022, the population aged 65 years or older increased by 57.4% (IBGE, 2024). This scenario contributes to the growing number of dementia cases — a progressive neurodegenerative condition that compromises cognitive functions, autonomy, quality of life, and nutritional status. Feeding difficulties in these patients often evolve into dysphagia, weight loss, and risk of malnutrition. In such cases, percutaneous endoscopic gastrostomy (PEG) is an alternative for long-term nutritional support. Although considered a safe procedure, its indication in advanced dementia remains controversial due to uncertainties regarding clinical benefits, complications, and ethical dilemmas. Objective: To analyze scientific evidence from the past ten years on the use of PEG in patients with advanced dementia. Method: Integrative review based on the Patient, Intervention, Comparison (PICO) strategy. Articles published between 2015 and 2025, in Portuguese, English, or Spanish, were included from the PubMed/MEDLINE, Embase, and BVS/LILACS databases. The search used controlled descriptors combined with Boolean operators. Selection occurred in two stages (title/abstract screening and full-text reading), followed by standardized data extraction and qualitative analysis with thematic categorization. Results: A total of 124 studies were identified. After exclusions, 20 were included in the review, grouped into three thematic categories: indications and criteria for PEG; clinical outcomes; and ethical aspects in decision-making. Conclusion: Although widely used, PEG in advanced dementia shows limited benefits and relevant risks. Its indication requires evidence-based institutional protocols, multidisciplinary communication with families, and multicenter studies assessing quality of life, cost-effectiveness, and the emotional impact on caregivers