Clinical outcome of geriatric patients in the United States receiving home parenteral and enteral nutrition

Abstract

In this study the use of home parenteral and enteral nutrition (HPEN) therapy in geriatric patients and the effect of aging on the clinical outcome of HPEN therapy was assessed between 1985 and 1992. Data were obtained from Medicare (part B) parenteral and enteral nutrition workload statistics, Blue Cross and Blue Shield of South Carolina, and the North American HPEN Patient Registry. On the basis of these data it was estimated that in 1992 there were 40,000 HPN patients and 152,000 HEN patients nationwide. One-quarter to one-third of the HPN group was aged > or = 65 y, depending on the underlying diagnosis. Geriatric HPN patients had a generally good outcome but did not do as well as their younger counterparts; however, they had fewer therapy-related complications than children. In the HEN group, 44% of cancer patients and 69% of patients with neuromuscular swallowing disorders were geriatric. Geriatric HEN patients with swallowing disorders had a poorer outcome (i.e., lower survival, poorer rehabilitation, and fewer resumed full oral nutrition) than younger patients after 1 y of follow-up. In conclusion, although aging was associated with a poorer outcome for HPN patients, it was still reasonably good; therefore, age per se should not exclude geriatric subjects from therapy. For HEN, the poorer outcome in geriatric dysphagic patients raises concern regarding the appropriateness of this therapy.