Prolonged tube feeding in long-term care: nutritional status and clinical outcomes.

Abstract

This study examines nutritional status and clinical outcomes, including pressure ulcers and death in 40 chronically tube-fed long-term care patients. Anthropometric, biochemical, clinical and dietary data were collected over a 3-month period, with follow-up of mortality at 1 year. Subjects' functional and cognitive status was generally poor. Adequate calories and protein were provided, with sample means exceeding standard means for energy, protein and micronutrients. Still, subjects showed weight loss and severe depletion of lean and fat body mass. Mean serum protein and micronutrient status measures were in the low normal range. Hemoglobin, hematocrit, and serum zinc and carotenoid levels were below normal in a sizable proportion of patients. Pressure ulcers were present in 65% of patients. Weight loss was associated with longer time on tube feeding and more pressure ulcers. Negative correlations with ulcer number were observed for cholesterol, albumin, zinc, retinol, alpha-tocopherol and iron. This study shows that despite administration of apparently adequate formula, micronutrient deficiencies and marasmic malnutrition exist in chronically ill patients. Causes may include the combined effects of chronic disease, sepsis, immobility, and severe neurologic deficits. Clinical outcomes may be expressions of an organism-wide diminution of protein synthesis, the cause of which is unknown. For clinical management, serial measures of weight, albumin, cholesterol, hemoglobin and hematocrit are recommended. Future research must address the many subsets of the population of chronically tube-fed patients.

Survival of a cohort of elderly patients with advanced dementia: nasogastric tube feeding as a risk factor for mortality

“…Tube feeding is very common among these patients for three main reasons: it avoids undernutrition, it prevents broncho-aspiration with the corresponding risk of pneumonia, and it prolongs survival. Numerous studies have shown that artificial feeding does not improve nutritional parameters or avoid nutritional worsening in patients with advanced dementia (Henderson et al, 1992;Finucane et al, 1999;Dharmarajan et al, 2001;Kim, 2001), data with which our results agree. However, our data do not agree with those studies reporting fewer respiratory infections in patients with NGT.…”

Weight Loss, Dysphagia, and Outcome in Advanced Dementia

“…Patients with severe neurological deficits and functional impairment do not do well even when provided with adequate calories and nutrients through enteral feeding [20,21]. In cases of lean body mass and weight decline, these patients develop a number of complications including decubiti; an impairment of the ability to synthesize protein [20] may be responsible.…”

“…In cases of lean body mass and weight decline, these patients develop a number of complications including decubiti; an impairment of the ability to synthesize protein [20] may be responsible. We believe our study population presents striking similarities with the patients in these studies and have termed this constellation the ''failure to thrive syndrome of advanced dementia.''…”

Helping the general physician to improve outcomes after PEG insertion: how we changed our practice

“…[7][8][9] Henderson and colleagues identified that longer-term tube feeding was actually associated with weight loss. 10 These complex ethical and legal dilemmas have been highlighted recently with the publication of new practical guidance from the Royal College of Physicians. 11 A reduced number of patients with advanced dementia alone undergoing PEG insertion was demonstrated in our unit following the introduction of preassessment.…”