Study of the timing for transition to tube feeding in elderly patients with eating and swallowing disorders

Abstract

Introduction: Enteral nutrition (EN) can improve the prognosis of older patients with oral intake difficulty. However, the decision to administer tube feeding is not easy especially when patients can eat a certain amount of food. In the present study, we examined the acceptable duration in which oral intake should be improved before deciding to administer tube feeding.
Subjects and Methods: The subjects were 112 patients referred to our nutrition support team. The relationship between clinical outcomes and duration for which enteral caloric intake was <60% of the total energy expenditure (TEE) (period of EN < 60%) was examined. The relationship between clinical outcomes and prognostic nutritional index (PNI) was also examined.
Results: 1) Patients in whom the period of EN < 60% was 15 days or longer had a higher incidence of swallowing disorders requiring supplemental nutrition with tube feeding. 2) Those in whom the period of EN < 60% was 29 days or longer had an increased mortality rate. 3) Patients with a PNI of 30 or more had a significantly higher survival rate after tube feeding.
Conclusions: The results suggest that the acceptable period in which oral intake should be improved before deciding to administer tube feeding is within 14 days from the time the patient starts to experience difficulty with adequate oral intake needed to meet the TEE. We consider that tube feeding should be administered between the 15th and 28th day of the period of EN < 60% or before the PNI falls below 30.