Tube Feedings in Elderly Patients

During an 11-month period, 70 tube-fed patients aged 65 to 95 years were studied prospectively to determine the indications, benefits, and complications of enteral alimentation. Indications for alimentation were refusal to swallow (35 patients 50%, dysphagia without obstruction (33 47%), and esophageal obstruction (two 3%). Nasogastric tubes (NGTs) were used initially in 69 patients; 15 of these subsequently required a gastrostomy tube (GT). One patient was treated initially with a gastrostomy. Indicators of nutritional status included weight, hemoglobin level, hematocrit, and serum albumin level. During the first two weeks the most common problems in the NGT group were agitation and self-extubation (36 patients 67%) and aspiration pneumonia (23 43%). In GT patients the most common early problems were aspiration pneumonia (nine patients 56%), tube dysfunction (eight 50%), and agitation and extubation (seven 44%). The common late problems were aspiration pneumonia (24 patients 44% in the NGT group and nine 56% in the GT group), and feeding tube dysfunction in six (38%) of the GT group. Self-extubation as a late problem was limited to the NGT group (21 patients 39%). Twenty-eight (40%) of the 70 patients died during the study period.