The commonest cause of mortality in nasogastric tube-fed patients is aspiration pneumonia. Įnteral tube feeding in patients with dementia confers no survival benefit or improvement in the quality of life, and there may be an increased risk of mortality. Feeding nasogastric tubes can also impair swallowing mechanics prolonging oral and pharyngeal transit times, although this is not thought to impact overall swallow function or aspiration risk. This leads to an increased risk of dislodgement. įeeding nasogastric tubes can be unpleasant and lead to agitation, particularly in individuals with already established delirium. Due to the impact of multimorbidity and advanced illnesses on malnutrition, there is limited evidence that enteral feeding achieves a sustained response in terms of biochemical markers, weight gain, and other clinical outcomes such as functional status, quality of life, in-patient morbidity, and mortality. There is a paucity of studies to evaluate the indications and clinical outcomes of enteral tube feeding in older patients outside the context of poststroke dysphagia and advanced dementia. Most evidence for enteral nutrition involves the first category of patients. Indications for nasogastric feeding can be broadly divided into two categories: (i) dysphagia (difficulties swallowing) and (ii) anorexia in intercurrent illness or chronic disease. identified that enteral nutrition can reduce the risk of developing pressure ulcers by 25% but the study included enteral tube feeding as well as oral nutritional support. The benefits of early nasogastric feeding in stroke patients are well established. These challenges relate to placement, confirmation of tube placement, dislodgement, and acting in patients' best interest when they lack capacity.Įnteral nutrition has been shown to improve the length of hospital stay and wound healing in selected populations. There are several challenges that are common with nasogastric tube feeding in the older population. The Challenges of Nasogastric Feeding in the Elderly In general, enteral nutrition is preferred to parenteral nutrition as it is more physiological, simpler, cheaper, and less complicated. Įnteral feeding is indicated for patients with a functional gastrointestinal tract, whereas parenteral feeding is more commonly used for patients with nonfunctional gastrointestinal tract. The muscle content of the body is greatly important because of its interrelationship with physical function, strength, and morbidity. In an elderly population, the size of these losses may be greater, as they are in addition to age-related losses in these compartments. The main body composition changes observed with starvation are a loss of fat-free mass (FFM) and fat mass. For example, ageing is frequently associated with decreases in taste, smell, deterioration in dental health, and decreases in appetite and physical activity. Malnutrition is not an inevitable side effect of ageing, but many changes associated with the process of ageing can promote malnutrition.

In order to meet the nutritional needs of this population, clinicians require skills for recognising and managing malnutrition. The prevalence of nutritional deficiency in the elderly is 15% in ambulatory outpatients, 25%–60% in institutionalised patients, and 35%–65% in hospitalized patients. Older people have an increased risk for comorbid conditions that predispose them to develop malnutrition.

Malnutrition is recognised as a crucial reversible factor for conditions presenting with sarcopenia and frailty. Older patients are a heterogeneous group, with a high prevalence of malnutrition, sarcopenia, and frailty. This article outlines some of these limitations and identifies innovative solutions to deliver more efficient care to improve patient outcomes. There are significant challenges that can disproportionately impact older people. Over 790,000 feeding tubes are inserted in the National Health Service (NHS) each year. In addition, poor dentition, reduced moisture in the oral cavity and age-related decline in function of masticatory muscles can compound any swallowing difficulty. Causes may be neurological, such as stroke, dementia, and delirium, or mechanical. Dysphagia in older people is very often multifactorial. Nasogastric feeding is commonly encountered in older patients (defined as over 65 years old) owing to dysphagia and malnutrition. It is used to deliver nutritional support and medications to patients who are unable to swallow or are unable to meet their nutritional requirements by mouth. A feeding nasogastric tube is a flexible, fine-bore, radio-opaque tube passed into the stomach via the nose.

In the tube