Enteral nutrition (oral liquid supplements and tube feeding) in geriatric patients and geriatric-neurologic rehabilitation

DGEM and DGG Guideline Enteral Nutrition

Dorothee Volkert, Romana Lenzen-Großimlinghaus, Ute Krys, Matthias Pirlich, Brigitte Herbst, Tatjana Schütz, Wolfrid Schröer, Wolfram Weinrebe, Johann Ockenga and Herbert Lochs

Nutrient and fluid intake is often compromised in elderly, multimorbid patients. Enteral nutrition by means of oral liquid supplements and tube feeding offers the possibility to increase or to insure nutrient intake in case of insufficient oral food intake.

The present guideline is intended to give evidence-based recommendations for the use of oral liquid supplements and tube feeding in geriatric patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference.

Enteral nutrition by means of oral liquid supplements is recommended for geriatric patients with malnutrition or at risk of malnutrition, in case of multimorbidity and frailty, and following femur fractures and orthopaedic-surgical procedures. In elderly people at risk of malnutrition oral liquid supplements may improve nutritional status, reduce length of hospital stay and lower mortality. After femur fractures and orthopaedic-surgery oral liquid supplements may reduce unfavourable outcome.

Tube feeding is clearly indicated in patients with neurologic dysphagia and is recommended in case of depression in order to overcome phases of severe loss of motivation and refusal to eat. In contrast, tube feeding is not indicated in final disease states, including final dementia, and in order to facilitate patient care and to save time. Independent of the indication, the decision for or against enteral nutrition has to be made individually, in line with the patient will and under consideration of comorbidities, severity of illness and prognosis.

Altogether, it is strongly recommended not to wait until severe malnutrition has developed, but to start enteral nutrition therapy early, as soon as a nutritional risk becomes apparent.

Keywords: Guideline / recommendations / geriatric patients / malnutrition / enteral nutrition / oral liquid supplementation / tube feeding