Clinical outcomes and complications of enteral nutrition among older adults

Several reviews or clinical trials published in the last years have not demonstrated that tube feeding can improve outcomes, including inhalation pneumonia, survival, pressure sores. Further, high rate of risks are recognized. Therefore, this practice should be discouraged for severely demented patients. The aim of this study was to assess the validity of these findings in a sanitary district in the Venetian Region, Italy, characterized by a fully integrated program of territorial-hospital care and where enteral nutrition (EN) is supervised by a specialized nutritional team (NT).

A distinctive aspect of this study concerns the fact that all patients with tube feeding were followed at home, in hospital, in nursing home by the same NT. The team controls the selection of patients and supports the follow-up, according to the guidelines of the Italian Society of Parenteral and Enteral nutrition. The study provides a prospective evaluation including 108 patients, mean age 78.2 years, followed for 12 months. Each patient underwent multidimensional tests, including activities of daily living, instrumental activities of daily living, Norton, Pfeiffer and Karnofsky scales, and anthropometric and biochemical indicators of nutritional status.

The main diagnoses were dementia (72 patients), stroke (23 patients), malignancy (5 patients), amyotrophic lateral sclerosis (3 patients) and miscellaneous disease (5 patients). EN was delivered by PEG (62 patient), NGT (45 patient), jejunostomy in one patient. The main complications of nasogastric tube versus PEG have been inhalation 15.5% and 7.9%, respectively, tube displacement 62.2%, and 4.7%, tube clogging 11.1% and 7.9 %. The first month mortality rate was 7.4% and 23.1% at one year. The mean survival was 674 days.

Almost all complications have been mild and could be managed throughout adequately. Their prevalence is low, with reference to the long period of follow-up, for a whole of 39420 days. Tube displacement is frequent with NGT but not with PEG and may be a cause of physical restraint, compromising in this way patient's quality of life. In this study, survival was nearly three times higher than reported in literature. These positive outcomes may be the result of two factors. First, the selection and follow-up program was supervised by the same nutritional team. Second, the network of integrated services of continuing care, including nursing homes, hospital and home care.