A 30-day probiotic intervention significantly increased alpha diversity and restored beneficial bacterial families in 16 elderly patients receiving home enteral nutrition. The treatment specifically boosted Lachnospiraceae and Erysipelotrichaceae populations, both linked to improved gut barrier function and anti-inflammatory effects. These findings address a critical gap in geriatric nutrition care, where tube-fed elderly patients face compounded challenges of age-related gut dysbiosis and artificial feeding-induced microbiome disruption. The rapid microbiome response within just one month is particularly encouraging, suggesting that even compromised elderly guts retain plasticity for beneficial change. However, the small sample size and lack of functional health outcomes limit immediate clinical applications. The study's focus on home enteral nutrition patients represents an underserved population where microbiome interventions could significantly impact quality of life and reduce complications like infections and inflammation. While preliminary, this research establishes proof-of-concept for probiotic therapy in this vulnerable demographic and provides microbiome targets for future larger trials incorporating clinical endpoints like infection rates, nutritional status, and inflammatory markers.