title: Older adults receiving home enteral nutrition: enteral regimen, provider involvement, and health care outcomes.
abstract: BACKGROUND
  Home enteral nutrition (HEN) is most frequently prescribed for older adults. Medicare reimbursement policy limits in-home nursing visits, and in-home professional nutrition services are restricted to those patients with diabetes or predialysis kidney disease. Most older adults receiving HEN rely on informal (family) caregivers to provide HEN care. The purpose of this study was to apply care process theory to identify and investigate variables related to health care outcomes of HEN in a sample of older adults dependent on informal caregivers. We assessed relationships among patient characteristics, the HEN regimen prescription and adherence, formal provider involvement, and health care outcomes.
  
  
  METHODS
  In-home interviews were conducted with a multiethnic (14 white, 8 Hispanic, 7 African American, 1 Asian) sample of 30 older adults (mean = 68.4 years) during their first 3 months of HEN (mean = 1.83 months).
  
  
  RESULTS
  Daily enteral intake averaged 1596 +/- 553 kcal. Gastrointestinal complications, occurring in up to 63.3% of patients, interrupted daily infusions. Further, one-third reported tube clogging or leaking, and one-third had tube displacement. Water intake was half of calculated need and associated with decreased urination (p = .001). Average weight change was -4.35 pounds (p = .001), and 17 patients had body mass indexes (BMIs) <18.5. Women had more complications (p = .004), lower enteral intake (p = .009), and lower BMIs (p = .02). Only 6 patients saw dietitians in follow-up care. Complications and type of feeding tube were associated with unscheduled health care visits and readmissions (p < .05).
  
  
  CONCLUSIONS
  The efficacy of HEN in older adults (ie, reversal of malnutrition and improvements in health, functionality and quality of life) requires more frequent monitoring, reassessment, and intervention from a highly skilled multidisciplinary team that includes dietitians.
authors.affiliation: Vanderbilt Center for Human Nutrition, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2713, USA. heidi.j.silver@vanderbilt.edu
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Silver
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Wellman
authors.forename: David J
authors.initials: DJ
authors.lastname: Arnold
authors.forename: Alan S
authors.initials: AS
authors.lastname: Livingstone
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Byers
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D017028:Caregivers / Q000193:education / Q000592:standards*; D002908:Chronic Disease / Q000628:therapy*; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000592:standards*; D005260:Female; D006701:Home Nursing / Q000379:methods* / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010349:Patient Compliance; D011787:Quality of Health Care; D012449:Safety; D016896:Treatment Outcome; D014481:United States