Enteral Nutrition

Enteral nutrition alludes to feeding that utilizes the gastrointestinal tract to meet the nutrition and hydration needs of an individual in specific settings. Aging is associated with physiological changes and complex comorbid conditions and, in many, frailty, weight loss, and malnutrition. When older adults are unable to meet their long-term nutritional needs through the traditional intake of food and liquids, consideration is given to oral supplements and tube feeding via the gastrointestinal tract. Decision-making regarding long-term artificial nutrition and hydration may be complex and must primarily consider the patient’s wishes or existing advance care planning information in the absence of decision-making capacity. In the absence of capacity, the caregiver or healthcare proxy’s preferences are considered, as long as they are consistent with the patient’s wishes. Decision-making regarding enteral nutrition may be influenced by ethical dilemmas; cultural or religious beliefs; a lack of understanding of the benefits and adverse consequences; emotional distress surrounding illness; cultural, ethical, and religious beliefs; and alternate means of feeding. Advance care planning, properly executed, is particularly helpful in enabling decisions regarding the introduction of enteral nutrition for individuals without capacity. Enteral nutrition is provided through the selection of an appropriate formula from numerous options, one that is tailored to offer benefits for specific disorders. However, enteral nutrition may also be associated with adverse effects such as metabolic and electrolyte abnormalities, diarrhea, aspiration pneumonia, and poorer quality of life. The different means of enteral support, associated benefits, and adverse effects are outlined in the chapter.