Factors Affecting Survival in Older Patients on Enteral Nutritional Support

The effects of clinical and laboratory characteristics on survival outcomes in older patients receiving enteral nutrition (EN) support are unclear.

We analysed the effects of clinical characteristics, comprehensive geriatric assessment scores and duration of nutritional support use on the survival outcomes of older patients who received enteral nutritional support in our Geriatrics Clinic.

Three hundred and thirty-nine patients were analysed, of whom 211 (62.2%) were female. The median age was 81 years (range: 65-102). Oral nutritional support was given to 321 (94.7%) patients, and 18 (5.3%) were given nutritional support via percutaneous endoscopic gastrostomy (PEG). The median MNA-SF, ADLs, IADL, MMTs and GDS-SF scores were 8 (1-14), 5 (0-6), 4 (0-8), 22 (0-30) and 5 (0-15), respectively. Male sex (HR = 2.403, 95% CI = 1.355-4.273; p = 0.003), older age [75-84 vs. 65-74 years; HR = 2.960, 95% CI = 1.010-8.677; p = 0.048 and > 85 versus 65-74 years; HR = 5.504, 95% CI = 1.854-16.335; p = 0.002], higher LDH (HR = 1.004, 95% CI = 1.002-1.006; p < 0.001), lower IADL score (HR = 1.215, 95% CI = 1.102-1.336; p < 0.001) and shorter ENS duration (HR = 1.269, 95% CI = 1.122-1.436; p < 0.001) were associated with worse survival. With a 1-month reduction in the enteral feeding period, the risk of death in the 5th month increased by 1.215 times, and the risk of death in the 10th month increased by 1.171 times; this effect diminished over time. The median survival of patients on nutritional support via PEG was 12 ± 2.9 months (range 6.2-17.7). The 1-year survival rate in the PEG group was 50%, and the 3-year survival rate was 12%. In the ONS group, the 1-year survival rate was 78%, and the 3-year survival rate was 55%.

Our results suggest that male sex, older age, high LDH levels, low IADL scores and shorter ENS duration may be associated with adverse survival outcomes in older patients receiving EN support.