1. The Effects of Pediatric & Geriatric Enteral Nutrition on Quality of Life Outcomes
E. Brooke Thevenin, B.S., Shannon Stephens, B.S., Pamela Holland, M.A., CCC-SLP, Craig Coleman, M.A., CCC-SLP, BCS-F
Marshall University Department of Communication Disorders
Introduction
Population-Based Results
Implications
Enteral nutrition, also known as tube feeding, is the process of transporting nutrients to the stomach, duodenum, or jejunum depending on the severity and period of time for which nutritional aid is necessary (Forchielli, Bines, Walker, Watkins, & Duggan, 1996). The necessity for this nutritional delivery method may stem from dysphagia or other disorders that result in loss of appetite, feeding difficulties, or swallowing function (Forchielli, et al., 1996). This literature review focuses on concerns surrounding enteral nutrition placements and quality of life outcomes in pediatric and geriatric patients, as well as their caregivers, by investigating both positive and negative outcomes in order to determine overall impacts on quality of life.
Shared positive and negative outcomes provide speech-language pathologists knowledge for clinical application. Positive and negative outcomes occur in any patient utilizing enteral nutrition, regardless of demographics. Speech-language pathologists can acquire knowledge of similarities across the lifespan and utilize this information when providing counseling, treatment, or diagnostic services to clients. In order to efficiently provide services to these populations, professionals should consider influential factors that impact quality of life both before and after enteral nutrition placements occur, as well as the client/caregiver views on quality versus quantity of life.
Pediatric Positive Outcomes
Pediatric Negative Outcomes
Physical Factors
Weight Gain, Physical Growth
Emotional/Social Factors
Decreased Stress Related to Feeding Given Oral Methods Were Previously Utilized
Access to Activities
Counseling Opportunities for Family/Caregivers
Nutritional Factors
Adequate Medication Delivery
Supportive of Transition to Oral Feeding
Decreased Dehydration Concerns
Vomiting, Refluxes :GER, GOR
Discomfort/ Pain, Skin Fragility
Loss of Oral Eating Abilities
Pneumonia
Pediatric Patient
Stress, Distrust of Adults
Parent/ Caregiver
Worry/Fear, Guilt, Depression, Decreased, Social Activity, Stress
Difficulty with Mealtime, Socialization, Difficulty with Concept of Mealtimes
Technical Factors
Leakage, Blockage, Placement/ Tube Related Factors
Methods
Limitations
A total of eleven research articles, six pediatric and five geriatric population studies, were selected based upon the following criterion:
Pediatric or geriatric population sample
Employment of nasogastric, gastrostomy, jejunostomy, and gastrojejunostomy enteral nutrition placements
Observation of the effects of enteral nutrition on patient/caregiver’s quality of life
Peer-reviewed research studies
The articles were located using research engines such as ASHA Wire, ASHA Practice Portal, Google Scholar, and EBSCO Host. Search terms for pediatric-based journals included “jejunostomy tubes and children”, “g-tubes and complications”, “children and enteral nutrition”, and “GJ-tubes” whereas the geriatric-based journal search terms included “dysphagia and geriatrics”, “geriatric feeding methods”, “enteral nutrition and dysphagia”, and “gastrostomy in geriatric populations”.
Researchers identified several limitations within this study design. In regards to the literature, few articles specifically examined individual aspects such as physical, emotional/social, nutritional, and technical factors. Expanding the inclusionary criterion to studies that observed these outcomes would provide more evidence to illustrate the positive and negative connections between enteral nutrition and quality of life outcomes. Moreover, the influence of factors such as underlying medical conditions on positive and negative outcomes were not examined, but these variables cannot be overlooked when examining patient outcomes. This may be worth consideration in future research. The methods by which positive and negative outcomes were measured within articles were also a limitation. The use of questionnaires and surveys assessed negative outcomes more so than positive outcomes, minimizing the positive outcomes that could be reported by patients.
Geriatric Positive Outcomes
Geriatric Negative Outcomes
Physical Factors
Increased Body Mass Index
Prevention of Malnutrition
Emotional/Social Factors
Caregiver Approval of Enteral Nutrition Delivery
Nutritional Factors
Ease of Feeding Procedures
Increased Delivery of Nutrients
Global Health Status, Digestive Concerns, Nausea, Fatigue,
Insomnia, Coughing/ Dyspnea, Infection
Social Functioning
Speech Difficulty
Role Functioning
Difficulty with Daily Activities
Emotional Functioning
Body Image/ Sexuality, Fear of Accidental Tube Removal, Depression, Financial Strain
Hunger, Diurnal/ Nocturnal Thirst
Technical Factors
Tube Displacement, Blockage .
References
Disclosures: Brooke Thevenin, Shannon Stephens, Pamela Holland, and Craig Coleman have no financial or non-financial relationships to disclose.
Special Thanks: The authors would like to give special thanks to the Department of Communication Disorders for their support in our research endeavors.
2015 Annual Convention of the American Speech-Language Hearing Association, Denver CO Session 8637 Poster 443
Please see the provided handout for a complete list of references.