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, 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:
- 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 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
- Hyper-or hypoglycemia
- Tissue damage due to extravasation
- Liver failure
- Micronutrient deficiencies
Resources Created by HHSC
- Evidence-Based Best Practice for Nutritional Support (PDF) addresses indications for and administration of nutritional support, including enteral and parenteral nutrition.
- Enteral Nutrition Formula Comparison Chart (PDF) provides information about commercially available enteral formulas, including indications for use, and caloric content. This is not an exhaustive list and does not constitute endorsement from HHS of any product or manufacturer.
- Enteral Nutrition Orders (PDF) describes the elements of an enteral nutrition prescription that should be present to prevent incorrect or incomplete orders.
- Checklist: Administering Enteral Nutrition (PDF) addresses elements of staff training and competency for enteral nutrition therapy and outlines the essential steps to providing enteral nutrition.
- Enteral Nutrition Care Plan (PDF) is a sample care plan that includes a scenario, measurable goals and person-centered interventions for an individual receiving enteral nutrition.
- Enteral Nutrition Education Form (PDF) is a sample form that NF staff can use to inform individuals and/or their representatives of the potential benefits, risks, burdens, and alternatives to enteral nutrition.
Resources from Other Organizations
American Society for Parenteral and Enteral Nutrition (ASPEN)
- ASPEN Safe Practices for Enteral Nutrition Therapy outlines the best practice approaches for enteral nutrition.
- ASPEN When is Enteral Nutrition Indicated? This consensus statement provides evidence-based indications for initiating enteral nutrition.
- ASPEN Parenteral Nutrition Safety Consensus Recommendations discusses best practices and clinical decision-making for initiating parenteral nutrition.
- ASPEN Care Transitions for Patients Receiving Parenteral Nutrition discusses the coordination needed to safely transition a person receiving parenteral nutrition from one level of care to another.
- ASPEN Enteral Nutrition Adult Formulas provides information on the composition and features of commercially manufactured enteral nutrition formulas.
- ASPEN Enteral Nutrition Modular Products is a list of products that provide specific nutrients such as amino acids, protein, pre/probiotics, or soluble fiber.
Academy of Nutrition and Dietetics
- Pocket Guide to Enteral Nutrition, 2nd Edition provides comprehensive information on the management of enteral nutrition. Note: Purchase is required to access this resource.
- Nutrition Care Manual provides evidence-based nutritional information, tools, and resources. Note: Purchase is required to access this resource.
National Institutes of Health (NIH)
- Enteral Tube Feeding for People with Severe Dementia (PDF) is a systematic literature review that evaluates the use of enteral nutrition therapy in people with advanced dementia.
- Current perspective for tube feeding in the elderly: from identifying malnutrition to providing of enteral nutrition (PDF) discusses issues related to malnutrition in older adults, tools for assessing nutritional status, and strategies for the appropriate use of enteral nutrition.
- European Society for Clinical Nutrition and Metabolism (ESPEN) Guideline on Ethical Aspects of Artificial Nutrition and Hydration is an evidence-based guideline that includes information on end-of-life issues, nursing care and the principle of bioethics related to artificial nutrition and hydration.
- Abbott Best Practices for Managing Tube Feeding: A Nurse’s Pocket Manual provides nursing staff with evidence-based information related to enteral nutrition, including care planning, infection control measures, and medication administration through an enteral feeding tube.