Home parenteral nutrition in older vs younger patients: Clinical characteristics and outcomes

Abstract

Background There is a demographic shift toward older patients receiving home parenteral nutrition (HPN), but data on clinical outcomes are limited. The objective of this study was to determine differences between older and younger HPN patients in regard to HPN indications, prescriptions, and outcomes over the first 2 years receiving HPN. Methods This was a retrospective analysis of prospectively collected data from HPN adult patients entered in the Canadian HPN Registry. New HPN patients enrolled between 2003 and 2017 and receiving HPN for at least 2 years were selected. Data included demographics, PN prescriptions, catheter‐related bloodstream infections (CRBSIs) over the past year, survival, and quality of life based on Karnofsky Performance Status (KPS). Results Four hundred two patients were included: 184 patients were ≥60 years old, and 219 patients were between 18 and 59 years old. There were no differences in the main indications for HPN, body mass index (BMI), and PN prescriptions at baseline. At 2 years, younger patients received more energy from PN than older patients (27.9 vs 19.6 kcal/kg; P < .001), but BMI remained comparable. There were fewer CRBSIs in the older group (20% vs 36%, P = .0023), but 78% of younger patients remained alive vs 69% in the older group (P = .0401). In those alive, the proportion of patients continuing to receive HPN was comparable and the proportion of patients with a KPS ≥60. Conclusions Older HPN patients have similar clinical characteristics as younger patients but have fewer CRBSIs and higher 2‐year mortality.

Trend Observations in Home Parenteral Nutrition. Prevalence, Hospitalizations and Costs: Results from a Nationwide Analysis of Health Care Provider Data

“…The effect of the changing age distribution on the outcomes of HPN patients' needs to be analyzed in future studies. A retrospective study from Canada showed that older patients on HPN have higher 2-year mortality but a lower risk of catheter-related bloodstream infections [21].…”

Quality of life assessment instruments in adult patients receiving home parenteral and enteral nutrition: A scoping review

“…Besides, the KPS is a graded scale from 0–100 with intervals of 10, and it is able to assess the ability of patients to perform ordinary tasks. This short scale is the one employed by the Canadian HPN Registry because of its convenience for nurses or clinicians to use in busy clinical settings 65 …”

“…This short scale is the one employed by the Canadian HPN Registry because of its convenience for nurses or clinicians to use in busy clinical settings. 65 Furthermore, most identified tools were selfadministered and multidimensional, composed of various items. These items were grouped into a variety of subscales or domains, like physical, psychological, social, general health, spiritual, and life condition.…”

“…68,69 Karnofsky performance scale (KPS) is usually completed by a managing clinician or nurse to evaluate the functional status of patients, and it was used by six studies. 28,29,[64][65][66][67] World Health Organization Quality of Life-Bref (WHOQoL-BREF), a 26-item version of the WHOQoL-100 assessment, was employed by two studies, 59,60 and Quality of Life Index (QLI) was used by one study. 62…”

Parenteral nutrition in acute intestinal failure amongst the elderly was not associated with adverse clinical outcomes when compared to younger patients

“…Given the propensity for the accrual of signi cant comorbidities in the elderly, there may be issues of poor glycemic control in those with diabetes mellitus and uid/electrolytes issues in those with underlying cardiac and renal impairment 8 . Despite the potential challenges of administering PN in the elderly, recent studies found that home PN is safe in elderly patients with a low risk of catheter related blood stream infections (CRBSI), especially in those who engage home care nursing services 9,10 . While most studies report the safety of long term home PN in medically stable elderly patients in in the community setting [9][10][11] , reported clinical outcomes of elderly patients with acute intestinal failure receiving PN in acute hospital setting remains limited.…”