An 85-year-old nursing home resident with anorexia and probable aspiration pneumonia; which nutrition plan would be most appropriate?

• A. start the patient on a regular oral diet with supplements
• B. establish central access with a peripherally inserted central catheter PICC
• C. establish peripheral access and initiate peripheral parenteral nutrition until enteral feedings can be established
• D. determine the most appropriate enteral feeding route and establish tube feeding

Answer: (D)

When a patient has a functioning GI tract but needs nutrition due to anorexia and a risk of aspiration, the preferred approach is to use enteral nutrition rather than oral supplementation or intravenous feeding. Enteral feeding supports gut integrity, lowers infection risk, and is generally less invasive and costly than parenteral nutrition. In a frail elderly resident with probable aspiration pneumonia, simply starting a regular oral diet with supplements would increase the risk of further aspiration and worsen respiratory status. Central venous access for parenteral nutrition bypasses the gut entirely and carries higher infection and metabolic complications, without addressing the aspiration risk or the need to preserve gut function. Therefore, the appropriate plan is to assess swallowing and determine the most suitable enteral feeding route to minimize aspiration (often a post-pyloric route like a nasojejunal tube) and then initiate tube feeding. This approach uses the gut for nutrition and targets the route that best reduces the likelihood of aspiration while meeting nutritional needs.