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Background: Home enteral nutrition (HEN) is most frequently prescribed for older adults. Medicare reimbursement policy limits in-home nursing visits, and in-home professional nutrition services are restricted to those patients with diabetes or predialysis kidney disease. Most older adults receiving HEN rely on informal (family) caregivers to provide HEN care. The purpose of this study was to apply care process theory to identify and investigate variables related to health care outcomes of HEN in a sample of older adults dependent on informal caregivers. We assessed relationships among patient characteristics, the HEN regimen prescription and adherence, formal provider involvement, and health care outcomes., Methods: In-home interviews were conducted with a multiethnic (14 white, 8 Hispanic, 7 African American, 1 Asian) sample of 30 older adults (mean = 68.4 years) during their first 3 months of HEN (mean = 1.83 months)., Results: Daily enteral intake averaged 1596 +/- 553 kcal. Gastrointestinal complications, occurring in up to 63.3% of patients, interrupted daily infusions. Further, one-third reported tube clogging or leaking, and one-third had tube displacement. Water intake was half of calculated need and associated with decreased urination (p = .001). Average weight change was -4.35 pounds (p = .001), and 17 patients had body mass indexes (BMIs) <18.5. Women had more complications (p = .004), lower enteral intake (p = .009), and lower BMIs (p = .02). Only 6 patients saw dietitians in follow-up care. Complications and type of feeding tube were associated with unscheduled health care visits and readmissions (p < .05)., Conclusion: The efficacy of HEN in older adults (ie, reversal of malnutrition and improvements in health, functionality and quality of life) requires more frequent monitoring, reassessment, and intervention from a highly skilled multidisciplinary team that includes dietitians.

Objectives: We used stress process theory to identify family caregiving variables that are salient to the experience of managing older adults' home enteral nutrition. In this article, we describe the specific tasks family caregivers performed and their unique training needs in the context of caregiver preparedness, competence, effectiveness, and health care use., Design: Hospital billing lists from two university-affiliated institutions in Miami, FL, were used to identify older adults who had enteral tubes placed over a 6-month period. Consent was obtained from those older adults discharged for the first time on home enteral nutrition and their family caregivers at the first scheduled outpatient visit., Subjects/setting: In-home interviews were conducted with a diverse sample of 30 family caregivers (14 white, 8 Hispanic, 7 African-American, 1 Asian) during their first 3 months (mean=1.83+/-0.69 months) of home enteral nutrition caregiving., Statistical Analyses Performed: Descriptive statistics were used to summarize data for all variables; chi(2) analysis was conducted to analyze differences in categorical variables. One-way analysis of variance was used to analyze mean differences among caregivers grouped by ethnicity for total number of hours and tasks performed. Post hoc comparisons were conducted using the Tukey HSD test. The Spearman rho correlations were calculated to assess bivariate associations between quantitative variables., Results: Caregivers reported providing from 6 to 168 hours of care weekly (mean=61.87+/-49.67 hours), in which they performed an average of 19.73+/-8.09 caregiving tasks daily. Training needs identified were greatest for technical and nutrition-related tasks. Preparedness for caregiving scores were low (mean=1.72, maximum=4.0) and positively correlated with caregiver competence (P<.001) and self-rated caregiver effectiveness (P=.004). Preparedness negatively correlated with health care use (P=.03)., Conclusions: Caregivers of older adults on home enteral nutrition need training for multiple nutrition-related and caregiving tasks. Multidisciplinary interventions, involving dietitian expertise, are needed to better prepare caregivers to improve both caregiver effectiveness and enteral nutrition outcomes.

Family caregivers, although uncompensated, provide daily care for more than 75% of the older adults who are dependent on home care technologies such as home enteral nutrition. The high complication rates and poor outcomes seen in older adults suggest that being an effective caregiver requires specialized training in home care technologies, and dietitians need to be more actively involved in discharge planning and follow-up home care. The level of knowledge and skill mastery required for technology-dependent care, along with the chronic, intensive nature of family caregiving and the disruptions in caregivers' daily lives, lead to negative emotional and physical consequences that may interfere with caregivers' ability to do caregiving well. Recognizing that care recipients and caregivers are underserved populations, dietitians should develop their professional competencies and expand their roles in technology-dependent home care. Dietitians can thereby contribute to better outcomes for both family caregivers and older home care recipients.

The chronic, demanding nature of family caregiving for frail older adults creates a high degree of stress for caregivers, called caregiver burden. Caregiver burden compromises caregivers' emotional and physical health and health-promoting behaviors. Deterioration in caregivers' health and nutritional status may put caregivers at risk for chronic disease, diminish the ability of caregivers to provide care, and impair the quality of life experienced by caregivers and care recipients. Nutrition education may help reduce caregiver stress and maintain caregivers' health and well-being. Mediating caregiver stress may allow family caregivers to meet their societal role, which has intensified because of health care cost containment.