Author/Year

Country of origin

Journal

Sample size

Objective

Results

Level of evidence

MEIER et al., 2001 [12]

USA

Arch Intern Med.

99

To assess the effects of feeding tubes on the survival of aged people with Advanced Dementia.

Feeding tube insertion predictors:

African-American ethnicity (OR: 9.43; 95% CI: 2.1 - 43.2)

Living in an ILPI (OR: 4.9; 95% CI: 1.02 - 2.5).

Using a tube is not associated with greater survival (p = 0.90).

1B

LEBOIVITZ et al., 2003 [13]

Israel

Journal of Gerontology: Medical Sciences

215

To analyze the oral microbiota of patients fed by means of NGT, oral route and PEG.

Prevalence:

Staphylococcus aureus in the NGT feed was 81%, 51% in PEG and 17.5% through the oral route, p = 0.0001.

Pseudomonas aeruginosa was 31% with NGT, 10% with PEG and 0% via the oral route, p = 0.001. Klebsiella and Proteus were isolated mainly in patients with NGT (p = 0.003).

2B

KAGANSKY et al., 2005 [14]

Israel

Am J Clin Nutr

414

To identify risk factors for malnutrition and the MNA score and their subpoints as predictors of in-hospital mortality.

Risk factors for malnutrition: low albumin and phosphorus concentrations, dementia and stroke. Lower survival in malnourished individuals and those at risk of malnutrition (p = 0.0001). Lower MNA scores were associated with laboratory indices of malnutrition and infections, malignancy, pressure injuries, dementia, recent orthopedic surgery, and stroke.

4

RABADI et al., 2008 [15]

USA

Neurology

116

To assess the effects of nutritional supplementation in malnourished stroke patients.

Intensive nutritional supplementation improved motor function when compared to standard supplementation (p = 0.002).

1A

MUDGE et al., 2011 [16]

Australia

Clin Nutr.

134

To assess the nutritional intake of hospitalized aged people and related factors.

Factors associated with inadequate intake:

Lack of appetite, high BMI, infection or cancer diagnosis, delirium and need for feeding assistance.

2B

KURODA; KURODA, 2012 [17]

Japan

J Am Geriatr Soc

55

To assess the relationship between thinness, swallowing and sarcopenic dysphagia.

Swallowing impairment was related to thinness rather than to frailty or dementia. Reduction in lean body mass, including swallowing muscles, is responsible for the association between decreased arm circumference and progressive loss of swallowing function (p = 0.48)

2B

BOSCH et al., 2012 [18]

Spain

Eur J Intern Med

120

To assess mortality and prognostic factors in demented patients with AP.

The swallowing test showed aspiration in 92.6%. Patients with recurrent AP (28.3%) took thickeners more frequently (61.8% vs. 11.6%, p = 0.0001). Mortality was 50.8% and was associated with age and worse functional capacity malnutrition. There was an association between low albumin levels and mortality at six months (OR: 1.13; 95% CI: 1.01 - 1.26, p = 0.03).

2B

KOMIYA et al., 2013 [19]

Japan

Geriatr Gerontol Int.

73

To determine the risk factors for unexpected death due to suffocation in aged people hospitalized for pneumonia.

Tube feeding after admission was associated with unexpected death due to suffocation (OR: 9.53; 95% CI: 1.03 - 88.26, p = 0.047).

2B

AMBAR et al., 2014 [20]

Israel

Clin Nutr.

50

To assess the effects of optimizing nutritional intake in aged patients undergoing hip fracture surgery.

The patients with higher daily energy intake had less negative cumulative energy balance than the Intervention Group (−1229.9 ± 1763 vs. −4975.5 ± 4368 kcal, p = 0.001) and a lower total complication rate (27.3% vs. 64.3%, p = 0.012). There was a reduction in infectious complications in the Intervention Group (13.6% vs. 50%, p = 0.008).

1C

CINTRA et al., 2014 [21]

Brazil

J Nutr Health Aging.

67

To assess the association between feeding route, survival, incidence of pneumonia and hospitalizations in aged people with Advanced Dementia.

At 3 months, 11.1% and 41.9% mortality in the oral feeding group and in the alternative feeding group, respectively (p = 0.004).

At 6 months, mortality increased to 27.8% and 58.1% (p = 0.012).

There was higher incidence of AP in the alternative feeding group (p = 0.006).

2B

MOMOSAKI et al., 2015 [22]

Japan

Geriatr Gerontol Int

98,374

To assess the effects of dysphagia rehabilitation after AP in older adults.

Oral intake at discharge was higher in the dysphagia rehabilitation group (OR: 1.32; p < 0.001).

2B

LOPES et al., 2015 [23]

Spain

Nutr. Hosp

182

To assess the factors related to in-hospital mortality in older adults with dysphagia.

Mortality was associated with age ≥ 85 years old, dysphagia, oncological disease, comorbidities, low functionality, MNA < 17 points, albumin < 3 g/dl and high doses of opioids, neuroleptics and antidepressants.

2B

POISSON et al., 2016 [24]

France

Gerodontology

156

To assess the association between oral condition, dysphagia and malnutrition in hospitalized aged people.

48.42% malnourished patients, 31.44% reduced salivary flow, 89.30% in need of oral treatment, 10.7% candidiasis and 21.8% dysphagia was observed.

There was an association between dysphagia and malnutrition (p < 0.001) and both were related to candidiasis (p < 0.001; p < 0.01). Dysphagia was related to salivary hypofunction (p < 0.001), dependence for oral self-care (p < 0.001) and dependence for self-feeding (p < 0.001).

2B

MAEDA et al., 2016 [25]

Japan

Clin Nutr.

331

To assess the recovery of patients with AP and swallowing.

NOR patients and/or without evaluation by the speech therapist and diet guidance resulted in worse nutritional intake (p < 0.05), longer treatments (NOR: 13 days (95% CI: 12.04 - 13.96) and EOI group 8 days (95% CI: 7.69 - 8.31, p < 0.001)) and greater decline in swallowing capacity throughout treatment (p < 0.001).

2B

PILGRIM et al., 2016 [26]

England

J Nutr Health Aging.

179

To assess the effects of lack of appetite on hospitalized aged women’s health.

Lack of appetite was associated with increased risk of in-hospital infections (OR: 3.53; 95% CI: 1.48 - 8.41, p = 0.004) and increased risk of death at six months (HR: 2.29; 95% CI: 1.12 - 4.68, p = 0.023).

2B

ZHANG et al., 2017 [27]

China

Biomed Environ Sci.

1343

To assess the nutritional status and measure HGS that would define malnutrition or nutritional risk in hospitalized aged people.

Nutritional risk was identified in 63.81% and malnutrition in 28.22%. HGS was associated with decreased malnutrition and nutritional risks. The HGS cutoff points were similar using different nutritional assessment scales: 24.9 kg vs. 27.5 kg (65 - 74 years old) and 20.8 kg vs. 21.0 kg (75 - 90 years old) for men and 15.2 kg vs. 17.0 kg (65 - 74 years old) and 13.5 kg vs. 14.6 kg (75 - 90 years old) for women.

2B

KURAOKA; NAKAYAMA, 2017 [28]

Japan

BMC Geriatr

45

To explore the factors that influence PEG placement regret after 6 months.

PEG placement (p < 0.01) and decision conflict (p < 0.001) are explanatory factors for decision regret regarding PEG placement among substitute decision-makers.

2B

MUR et al., 2017 [29]

Spain

Semergen

266

To assess the presence of dysphagia in hospitalized aged people.

Dysphagia was diagnosed in 86%.

Enteral nutrition was implemented in 10.9%.

The mean survival was 230.8 ± 256.5 days.

There were differences in 12-month survival in patients who tested positive (p = 0.065).

2B

TAKAYAMA et al., 2017 [30]

Japan

Psychogeriatrics

185

To assess survival of older adults with psychiatric disorder on enteral tubes.

The mean survival time was 711 days in patients with tubes and 61 days for patients without tubes, p < 0.001. In a comparison of tube types, survival was 611 days for NGT and more than 1000 days for PEG.

2B

CLAYTON et al., 2018 [31]

Australia

Burns

66

To determine the prevalence and risk factors for dysphagia in hospitalized aged people with severe burns.

The prevalence of dysphagia was 46.97%.

Dysphagic patients presented longer hospitalization times (33.61 vs 13.86 days, p < 0.001), more in-hospital complications (68% vs 9%, p < 0.001), a higher mortality rate (23% vs. 0%, p = 0.003) and increased need for mechanical ventilation (26% vs. 0%, p = 0.001).

Dysphagia was associated with burn size (OR: 1.24; 95% CI: 1.11 - 1.43, p = 0.0011), prior cognitive impairment (OR: 5.08; 95% CI: 1.37 - 24.68, p = 0.0232) and severe malnutrition (OR: 4.18; 95% CI: 1.27 - 15.62, p = 0.0233).

2B

EGLSEER et al., 2018 [32]

Austria

J Nutr Health Aging

3174

To assess the association between dysphagia, malnutrition and nutritional interventions in dysphagic aged people.

The prevalence of dysphagia and malnutrition was 7.6% and 20.7%, respectively.

Malnutrition in dysphagic patients was 37% vs. 19.7% in non-dysphagic ones, p < 0.001. Dysphagic patients had a lower BMI (25 ± 4.8 vs. 26.1 ± 4.7, p = 0.01), multimorbidities (3 ± 1.9 vs. 2.7±1.7, p = 0.003), and greater dependence for ADLs (78% vs. 51%, p < 0.001) and for care (44.2 vs. 11.7, p < 0.001).

2B

APPEL-DA SILVA et al., 2019 [33]

Brazil

Nutr Hosp

133

To profile older adults with PEG in a hospital from southern Brazil.

The main indication was dementia, followed by stroke.

Malnutrition was observed in 68.4% and procedure-related complications, in 23.0%.

2B

KATAGIRI et al., 2019 [34]

Japan

Front Cell Infect Microbiol

8

To assess the composition of oral/intestinal microbial communities upon oral intake resumption.

Oral food intake in patients with subacute stroke and dysphagia increases diversity and composition of the oral and intestinal microbiome and were drastically different.

2C

LIN et al., 2019 [35]

China

PLoS One

745

To assess the impacts of nutritional support on hospitalized aged people.

Nutritional support reduces hospitalization time in patients at nutritional and malnutrition risk (p < 0.05).

Patients who received nutritional support had lower incidence of infections, p < 0.05.

2B

HE et al., 2019 [36]

China

J Orthop Surg Res.

306

To investigate the effects of oral nutritional supplementation after hip arthroplasty in aged patients with hypoalbuminemia.

Patients with nutritional supplementation had less wound effusion (OR: 0.57; 95% CI: 0.36 - 0.91, p < 0.05), a lower surgical site infection rate (OR: 0.40; 95% CI: 0.17 - 0.91, p < 0.05), fewer joint infections (OR: 0.26; 95% CI: 0.08 - 0.79, p < 0.05) and fewer readmissions (OR: 0.22; 95% CI: 0.06 - 0.79, p < 0.05).

2B

CASTANON et al., 2020 [37]

USA

J Burn Care Res

324

To assess the impact of early enteral nutrition in patients with thermal burns and wound healing.

The early enteral nutrition group had lower rates of infectious complications (7.8% vs. 16.7%; p = 0.040), mortality (15.6% vs. 26.1%; p = 0.044), hospitalization time (17 days vs. 20 days; p = 0.042) and ICU stay (13 days vs. 17 days; p = 0.042).

2B

TRAN et al., 2020 [38]

Vietnam

J Nutr Sci Vitaminol

1007

To investigate the nutritional status and dietary practices of hospitalized dysphagic aged people.

There were 29% malnourished and 54% at risk of malnutrition. Nearly 78% of the dysphagic older adults had oral food intake and 22% by tube. Almost all dysphagic patients had their food intake reduced in the last 3 months.

2B

FORMISANO et al., 2020 [39]

Italy

Nutrition

94

To develop a protocol for the nutritional management of patients with COVID-19.

19.1% of the older adults in the wards evolved to death, BMI 25.2 ± 4.4 and age 74 ± 15, polymorbidity (≥1) 81.9%.

Of these patients 37.2% received basic diet; 9.6% oral nutritional supplementation; 19.1% basic diet and oral supplementation; 7.4% enteral nutrition, 5.3% parenteral nutrition; 7.4% basic diet, oral supplementation and parenteral nutrition and 13.8% a personalized diet.

2C

LAI et al., 2020 [40]

China

Eur J Clin Nutr

358

To investigate nutritional risk, malnutrition and nutritional support status in long-lived older adults and develop a nutritional intervention plan.

Nutritional risk was observed in 50.3%. Of them, 58.9% received nutritional support. Malnutrition reached 36%.

Age (p < 0.001), living conditions (p = 0.009), number of chronic diseases (p < 0.001), attention to nutritional knowledge (p = 0.007) and ADLs (p < 0.001) were nutritional risk factors in the older adults.

2B

OLSEN et al., 2021 [41]

Norway

Eur Geriatr Med.

85

To assess the effects of two feedback protocols on hand grip strength, mortality and feedback syndrome.

HGS was similar after 3 months with a mean variation of 0.42 kg (95% CI: 2.52 - 3.36, p = 0.78). There was no difference in mortality (39% vs. 34.1%, p = 0.64). The Intervention Group had greater respiratory distress (53.6% vs. 30.2%, p = 0.029).

1B

SUZUKI et al., 2022 [42]

Japan

J Neurol Sci.

118

To assess the reduction in the enteral nutrition administration time in acute stroke with dysphagia.

There were no significant differences in the frequency of diarrhea (42% vs. 42%, p = 1), vomiting (0% vs. 7%, p = 0.29) or pneumonia (15% vs. 7%, p = 0.41).

2B

ZHAO et al., 2022 [43]

China

Lancet Neurol.

315

To compare the efficacy and safety of enteral feeding strategies in patients with severe stroke.

Poor results did not differ (82% modified complete EN vs. 80% complete EN (OR: 0.87; 95% CI: 0.41 - 1.86, p = 0.721); hypocaloric EN vs. 80% complete EN (OR: 0.61; 95% CI: 0.30-1.27, p = 0.186); hypocaloric EN vs. Modified complete EN (OR: 0.70; 95% CI: 0.34 - 1.46, p = 0.340).

90-day mortality due to hypocaloric EN was higher than for modified complete EN 34% vs. 17% (OR: 2.89; 95% CI: 1.46 - 5.72, p = 0.0023), and less significant between hypocaloric EN and complete EN: 23% (OR: 1.92; 95% CI: 1.00 - 3.69, p = 0.049).

1A

CHEN et al., 2022 [44]

China

Comput Math Methods Med

300

To assess the effect of nutritional supports on nutritional status, immune function, intestinal motility and complications in gastrointestinal tumors.

Hemoglobin, transferrin, prealbumin and albumin in the TPN group were lower than in EEN (p < 0.01). The immunoglobulin indices (IgG, IgM and IgA) were lower in TPN, and the T-lymphocyte subpopulations (CD4, CD8 and CD4/CD8) showed that the immune system in the EEN group was higher, p < 0.01.

Intestinal peristalsis, the time of the first defecation in the EEN group was shorter than in the TPN group (p < 0.01) during the perioperative period.

2B

YUEN et al., 2022 [45]

China

J Am Med Dir Assoc.

764

To compare survival, pneumonia risk and outcomes in hospitalized aged people with Alzheimer’s dementia fed by means of NGT and CMF.

Behavioral feeding problems were observed in 33%, dysphagia in 50%, or both in 17%.

There was no difference in the survival rate between the NGT and CMF groups (36% vs. 37%, p = 0.71).

The pneumonia rate was lower in the CMF group (48% vs. 60%, p = 0.004).

NGT use was a risk factor for pneumonia (OR: 1.41; 95% CI: 1.08 - 1.85).

2B