Nutritional Strategies for Tube Feeding in Elderly Patients with COPD

Enteral feeding

Hello, nutritionist.
I have an 84-year-old male patient weighing 35 kg and standing 160 cm tall.
He has been bedridden for a long time and is diagnosed with COPD and a history of stroke.
He is currently receiving enteral feeding via a nasogastric tube, with a daily intake of approximately 1250-1500 calories from nutritional supplements like Ensure and Pulmonary Support for over six months.
However, his weight has not increased, and he has pressure ulcers that are difficult to heal.
Could you please advise on additional food supplements or adjustments to the enteral feeding formula? Thank you!

yu, 30~39 year old female. Ask Date: 2017/03/10

Dr. Cai Xiuwen reply Nutrition

Hello! An 84-year-old male, weighing 35 kg and standing 160 cm tall, has been bedridden for a long time and is diagnosed with COPD and a history of stroke.
He is receiving enteral nutrition via a nasogastric tube, with a daily intake of 1250-1500 calories from a nutritional formula.
This regimen has been maintained for over six months, but his weight has not increased, and he has pressure ulcers that are difficult to heal.
Recommendations are as follows:
1.
Increase caloric intake to 1700 calories.
If renal function is acceptable, protein intake should also be increased.
2.
Confirm whether the nutritional formula being used is high in nitrogen and fiber.
If not, it is recommended to either increase the protein content or switch to a high-protein formula to aid in the healing of pressure ulcers.
3.
If daily digestion and absorption are adequate, consider increasing the formula by approximately 100 cc per meal to boost caloric intake, or add an additional meal.
4.
For COPD management, unless there is an acute infection or significant shortness of breath, long-term use of the current nutritional formula is not recommended due to its high fat content.
Switching from a high-fat to a high-protein formula may be more beneficial for pressure ulcer healing.
Wishing you safety and health.
This information is provided by Dietitian Tsai Hsiu-Wen from Nantou Hospital, Ministry of Health and Welfare.

Reply Date: 2017/03/10

More Info

In addressing the nutritional strategies for tube feeding in elderly patients with Chronic Obstructive Pulmonary Disease (COPD), particularly for the case of an 84-year-old male patient who has been tube-fed for over six months without weight gain and is experiencing difficulty with wound healing, several key considerations must be taken into account.

Nutritional Needs Assessment
1. Caloric Requirements: The current caloric intake of 1250-1500 kcal may be insufficient for this patient, especially considering his long-term bed rest and the energy demands associated with COPD. It is recommended to increase caloric intake to approximately 1700 kcal per day. This can be achieved by increasing the volume of the current feeding formula or adding additional meals.

2. Protein Intake: Protein is crucial for wound healing and muscle maintenance, particularly in patients with pressure ulcers. If the renal function allows, increasing protein intake is essential. High-protein formulas should be considered, as they can support tissue repair and help in managing pressure ulcers. A high-nitrogen, high-fiber formula may also be beneficial.

3. Hydration: Adequate hydration is vital, especially in patients with COPD, as it can help thin mucus and improve respiratory function. Ensure that the patient is receiving sufficient fluids through the tube feeding regimen.

Adjustments to Tube Feeding
1. Formula Selection: If the current formula (益力壯 and 保肺壯) is not meeting the nutritional needs, consider switching to a high-protein formula specifically designed for patients with pressure ulcers or those with increased protein needs. Formulas enriched with arginine, omega-3 fatty acids, and antioxidants may also promote wound healing.

2. Volume and Frequency: If the patient tolerates it, increasing the volume of each feeding by 100cc or adding an additional feeding could help meet caloric needs. Monitor for any signs of gastrointestinal discomfort or intolerance.

3. Feeding Rate: Slowing down the feeding rate can improve digestion and absorption, which may help in reducing the risk of aspiration and reflux. Aim for a feeding duration of 20-30 minutes per meal.

Monitoring and Evaluation
1. Regular Assessment: Continuous monitoring of the patient’s weight, nutritional status, and wound healing progress is essential. Collaborating with a registered dietitian can provide tailored nutritional interventions based on the patient’s evolving needs.

2. Digestive Health: If the patient experiences gastrointestinal issues, consider evaluating the feeding formula for fiber content and adjusting it accordingly. A formula with added fiber may help with bowel regularity and overall digestive health.

3. Supplementation: If the patient continues to struggle with weight gain, consider additional nutritional supplements that can be administered via tube feeding, such as protein powders or specialized nutritional drinks that can provide extra calories and protein without significantly increasing the volume of intake.

Conclusion
In summary, for elderly patients with COPD who are tube-fed, it is crucial to ensure that their nutritional needs are adequately met through careful assessment and adjustment of their feeding regimen. Increasing caloric and protein intake, selecting appropriate formulas, and monitoring the patient's response are key strategies to promote weight gain and enhance wound healing. Collaboration with healthcare professionals, including dietitians and nurses, will ensure a comprehensive approach to the patient’s nutritional management.

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