Artificial Nutrition in Elderly Individuals

Artificial nutrition refers to the provision of nutrients by means other than an individual consuming food or fluid orally and is sometimes (but not always) indicated when individuals are unable to meet their nutritional requirements via oral intake.  This may occur for a variety of reasons including stroke, head and neck cancers and neurological conditions such as multiple sclerosis and motor neurone disease.

There are several considerations which need to be made when contemplating whether artificial nutrition (sometimes called enteral nutrition) is appropriate for an individual, including their goals of care and whether or not artificial nutrition will aid in meeting these goals. For elderly individuals who may be experiencing a range of complex physical, mental and cognitive issues, this decision is often not an easy one to make with careful consideration given to their general prognosis and treatment preferences.

Artificial nutrition is not recommended in individuals with advanced dementia, and is often not indicated as part of end of life care where the goals of care are focused on providing comfort. There is no substantial evidence to suggest that artificial nutrition in these situations will improve quality of life, and it may actually decrease quality of life. Furthermore, it is known that reduced oral intake does not contribute to suffering at the end of life, which is often a concern of family members of a dying individual who is either refusing or is no longer able to eat or drink.

Enteral nutrition is not recommended in advance dementia or as part of end of life care

 

Individuals who are admitted into a residential aged care facility with an artificial feeding tube (commonly called a PEG) require specialised nursing care. It is recommended that nursing staff are skilled in PEG site care, tube care, administering medications and water flushes and administering feeds using various methods (e.g. gravity, syringe and pump).

How Dietitians can help?

Dietitians play a key role in the care of a resident with an artificial feeding tube as they can calculate the resident’s requirements for essential nutrients and devise a tailored feeding regime to suit their needs. A feeding regime takes into account the type of formula, the volume required and the times of the day it is to be administered. Dietitian reviews are recommended every 3-6 months to assess whether any changes to the regime are needed. Dietitians can also provide useful advice if the resident is experiencing any troubleshooting issues such as blocked feeding tubes, reflux, aspiration or gastrointestinal concerns such as bloating, vomiting, constipation or diarrhoea.

Contact your Leading Nutrition dietitian for advice on any residents who require artificial feeding or to schedule in an education session for staff who require up-skilling in the area.