P. Pfitzenmeyer*, P. Manckoundia*, C Mischis-Troussard*, Ph. d'Athis**, M. Michel***, M.D. Lussier****, B. Derycke*****, R. Hermet******, M. Collart*******, P. Leurs********, and le Club Francophone Gériatrie et Nutrition

*Service de Médecine Gériatrie. Centre de Champmaillot. 2, rue Jules Violle. 21034 Dijon cédex. **Service de biostatistique, informatique médicale et département d'information médicale. CHU Le Bocage 21034 Dijon cédex. ***Service de Médecine Gériatre ; La Tauvrais. 35033 Rennes cédex 09. ****Service de Médecine et Gériatrie. Hôpital La Milétrie. BP 577, 86021 Poitiers cédex. *****Hôpital Joffre ; rue Louis Camatte 91210 Draveil. ******Hôpital Nord CHU. BP 56, 63118 Cébazat. *******Résidence Comte Henri. 101 avenue Anatole France, centre hospitalier 10003 Troyes. ********Centre hospitalier. 19, rue des Anciens d'AFN. 59230 Saint-Amand-les-eaux. Correspondence: Professor Pierre Pfitzenmeyer, Service de Médecine Interne Gériatrique. Centre de Champmaillot. 2, rue Jules Violle CHRU Dijon, F-21034 Dijon, France. Tel: 03 80 29 39 70 Fax: 03 80 29 36 21
Email: ppfitzenmeyer@chu-dijon.fr

BACKGROUND: No previous studies have demonstrated either a nutritional improvement, or a survival benefit from tube placement in an institutionalized population. OBJECTIVE: The aim of this study was to determine current indications for tube feeding in French geriatric centers and to evaluate clinical outcome and mortality rates in these frail very old patients. DESIGN: Between November 1, 2000 and April 31, 2001, we prospectively recruited all hospitalized or institutionalized patients who received enteral nutrition (EN) in 7 Departments of Geriatric Medicine in France. Nutritional parameters and main indications of EN were recorded at the time of feeding tube placement. Pneumonia and mortality rates were observed over a period of one year. RESULTS: 57 patients of mean age 81.6 ± 7.8 yrs underwent placement of a feeding tube. Mean BMI value was 20.7 ± 4.8 and mean serum albumin level 26.1 ± 6.1 g/L. The most frequent indications for EN included stoke (39%) and other neurologic diseases (42%). Fourteen patients (25%) died within 30 days, and 27 (47%) died over the 12-month follow-up period. During the first month, an episode of pneumonia was noted in 26 cases (55%). CONCLUSION: The similarity between rates of early mortality reported in our study and those reported in several previous studies involving younger, ambulatory subjects is surprising because we might expect poorer survival in our frail elderly patients. We can think that French geriatric teams have changed their attitudes toward EN in recent years, EN being less frequently used in patients with advanced dementia and at the end-stage of life.

Keywords: Enteral nutrition, frail elderly, aging, prognosis.