1. Kennedy, Maureen Shawn MA, RN

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Although enteral nutrition can prevent malnutrition, and it can be administered in the home safely and inexpensively, a recent study has revealed that when given by "informal caregivers" enteral nutrition may be far less than adequate.


Enteral nutrition is indicated in a number of conditions common in older adults, such as swallowing disorders, cancer, or particular bowel disorders, but Medicare doesn't cover professional home feeding services unless the recipient has diabetes or kidney disease-and even in those cases, home visits are severely limited. Responsibility for such care, then, often falls to unpaid family members, friends, or neighbors.


The study enrolled 30 Miami, Florida, residents over 60 years of age with surgically implanted gastric or jejunal feeding tubes and discharge instructions for home enteral feeding to be managed by informal caregivers. Patients were examined and patients and care-givers interviewed one to three months after discharge to determine patients' functional status, the rate of complications arising from the feeding, nutritional and hydration status, their scores on quality-of-life indicators, and their need for additional health care services.


The majority of the patients experienced complications. Twenty-two patients (73%) reported irritation or discharge at the tube site; gastrointestinal symptoms such as diarrhea, constipation, and nausea were common, occurring in over one-third of patients. Clogs or leaks in the tube or pump malfunction were also numerous. A number of patients experienced daily interruptions in feeding. Patients who reported complications tended to find it difficult to perform "intermediate" activities of daily living, such as walking several blocks, climbing stairs, driving, and shopping. Many patients had lost weight, were undernourished (particularly those who also took some food orally), or were not taking in enough water. These problems were most evident in the female patients. Most of those who experienced complications rated the quality of their lives as poor.


The authors suggest that outcomes could improve with "frequent monitoring, reassessment, and intervention from a highly skilled multidisciplinary team that includes dieticians" and recommend further research to determine efficient protocols for preventing such problems. -Doug Brandt


Silver HJ, et al. JPEN J Parenter Enteral Nutr 2004;28(2):92-8.