Survival Outcomes in Older Palliative Care Patients With Impaired Swallowing Function Receiving Only IV Fluid Support: A Retrospective Observational Study

This study aimed to describe survival after initiation of nil per os (NPO) in older adults who lost swallowing function and were managed with IV fluids alone, and to examine differences according to terminal clinical course. Patients and methods This retrospective study included patients hospitalized with pneumonia (April 2015-March 2025) who recovered from pneumonia but developed irreversible swallowing impairment, could not take food orally, were managed under an NPO policy, and died during the same hospitalization. Patients were classified into three groups according to the principal cause of death: senility, recurrent pneumonia, and other causes. Patients who died before recovery from the pneumonia that led to hospitalization were excluded. The primary outcome was days from NPO initiation to death, and secondary analyses compared clinical and laboratory characteristics among groups. Results A total of 255 patients were identified during the 10-year study period through initial screening, and 68 were included in the analysis after excluding 183 patients who died before recovery from the pneumonia that led to hospitalization and 4 patients who had received high-calorie parenteral nutrition during hospitalization. These patients were classified according to the cause of death into a senility group (n = 33), a recurrent pneumonia group (n = 24), and an other-cause group (n = 11). Median survival after NPO onset differed among groups (p < 0.01) and was significantly longer in the senility group (30.0 days, 19.0-47.0) than in the recurrent pneumonia group (14.5 days, 7.5-17.0). Baseline clinicodemographic characteristics did not differ among groups, except for sex; BMI and WBC counts tended to be lower in the senility group. Conclusions Among older adults receiving IV fluids alone after loss of swallowing function, survival after NPO initiation differed according to terminal clinical course, with the longest survival observed in the senility group.