Nutrition Support (Enteral and Parenteral)

Maintaining a healthy nutritional status helps preserve physical functioning and reduce medical complications in older adults living in long-term care facilities. Common issues that can impact an older adult’s nutritional status include:

  • Social isolation and depression that can make food less appealing
  • Changes related to aging, such as functional impairment, reduction in taste, and decreased sense of hunger or thirst
  • Chronic health issues such as Parkinson’s disease, cancer, diabetes or Alzheimer’s disease
  • Polypharmacy and medication side effects such as nausea or vomiting
  • Sensory losses that impact the ability to see, smell, or taste food
  • Oral or dental issues, including difficulty chewing or swallowing ability

Any of these issues can increase the potential for unintended weight loss and malnutrition, resulting in a need for nutrition support including enteral or parenteral nutrition therapy.

Enteral Nutrition

Enteral nutrition, often referred to as “tube feeding” is the delivery of nutrients and fluids through a nasogastric, gastrostomy or jejunostomy feeding tube. It is generally recommended when a person is unable to meet their nutritional needs through oral intake, but still has a functional gastrointestinal tract.

Common indications for the use of enteral nutrition include:

  • Dysphagia after a stroke
  • Diseases that lead to malabsorption, such as inflammatory bowel disease, gastrointestinal cancer, short bowel syndrome
  • Progressive diseases that cause functional or swallowing problems, such as Parkinson’s disease, cancer, or amyotrophic lateral sclerosis

For people with dementia at the end of life, enteral nutrition has not been shown to improve nutritional status, reduce the incidence of pressure injuries, or reduce mortality risk.

Complications associated with enteral nutrition include:

  • Aspiration
  • Misplacement or dislodgement of the feeding tube
  • Clogging of the feeding tube
  • Refeeding syndrome
  • Medication related complications
  • Infection at the insertion site
  • Agitation or psychosocial issues

Parenteral Nutrition

Parenteral nutrition is the delivery of fluids, medications, and/or nutrition through an intravenous route, including Total Parenteral Nutrition.

While use of parenteral therapy is increasing overall, it is not a common form of nutritional support in long-term care facilities. Parenteral nutrition is usually a short-term intervention, during an acute illness or until enteral nutrition or oral intake can be tolerated.

Common indications for parenteral therapy include:

  • Malnutrition, including preoperative or postoperative malnutrition
  • Chronic intestinal obstruction or pseudo-obstruction
  • Short bowel syndrome
  • Intestinal injury or trauma
  • An inability to supply or maintain nutrition through enteral routes

Complications associated with parenteral nutrition include:

  • Dehydration or electrolyte imbalance
  • Thrombosis
  • Hyper-or hypoglycemia
  • Infection
  • Tissue damage due to extravasation
  • Liver failure
  • Micronutrient deficiencies

Resources Created by HHSC

Resources from Other Organizations

American Society for Parenteral and Enteral Nutrition (ASPEN)

Academy of Nutrition and Dietetics

National Institutes of Health (NIH)

Other Resources