In an older adult who requires long-term enteral nutrition, which complication is most often overlooked?

• A. Tube leaking
• B. Tube clogging
• C. Decreased urine output
• D. Skin problems at the tube site

Answer: (C)

Monitoring hydration status is essential for older adults on long-term enteral nutrition because decreased urine output often signals underhydration and reduced renal perfusion, a risk that is easy to miss in this population. While tube-related issues like leaking, clogging, or skin breakdown are common and typically evident during care, quietly reduced urine output can be overlooked, yet it may reflect insufficient fluid delivery or impaired kidney function. In older adults, thirst perception may be blunted and comorbidities or medications can affect fluid balance, so careful tracking of urine output helps catch dehydration early.

Regularly measure urine output, watch for signs of dehydration (dry mucous membranes, skin turgor changes, weight loss, orthostatic symptoms), and assess daily fluid needs. Ensure adequate free water is provided with and between feeds according to protocol, and adjust as needed based on urine output and lab markers (e.g., BUN/creatinine, electrolytes). This vigilance helps prevent dehydration-related complications even when the tube itself is functioning properly.