The Prognosis of Elderly Patients Who Have Lost the Ability To Receive Oral Intake and Are Treated with Peripheral Solution

Dear Editor:

The use of tube feeding in elderly patients with a poor oral intake due to old age remains controversial. ¹ Currently, the number of people who do not wish to be tube fed is increasing because of ethical aspects and the associated risks in regard to aspiration pneumonia. ² Such people are usually given drip infusions alone in the hospital until their death. However, the duration of survival following the loss of ability to receive oral intake has not been fully assessed. Medical professionals who work with the elderly are required to inform such patients and/or their families of the prognosis when the patient chooses not to be tube fed. We evaluated the survival of elderly patients who have lost the ability to receive oral intake and were treated with peripheral solution alone.

The patients included in our investigation were diagnosed to have ‘age-related physical debility’ according to the International Classification of Diseases (ICD-10) at Tenshindo Hetsugi Hospital between June 2008 and September 2012. In each case, the diagnosis was determined after reviewing the patient's clinical records. Elderly patients who had previously been tube fed or used a mechanical ventilator were excluded from this study. We defined ‘the onset of oral intake disability’ as the date when the average daily dietary intake decreased by more than 90% without further improvement. The number of days of survival from ‘the onset of oral intake disability’ to death in patients who received peripheral solution alone were recorded. Some of the subjects had been included in previous studies.^3–5 We analyzed 10 males and 8 females with a median age of 85.5 (range, 79–103) years. The median survival time from ‘the onset of oral intake disability’ was 46.5 (range, 10–104) days.

There have been no reports thus far concerning survival times in patients treated with a minimum of peripheral solution after discontinuation of oral intake. Our results may not be generalized to the entire population, because the definition of ‘age-related physical disability’ varies, even among clinical physicians. However, when considering a patient's quality of life along with longevity, the present results can be regarded as useful information for physicians. Because this study's sample size was very small, further large prospective investigations of the clinical characteristics of oldest-old patients who do not receive tube feeding are needed in the future.

In conclusion, in this investigation, the survival time from ‘the onset of oral intake disability’ in elderly patients who died from ‘age-related physical debility’ after being treated with peripheral solution alone was approximately a month and a half. This result may prove helpful for generating further discussion about the optimal nutritional methods for treating elderly patients nearing the end of their life.