November is National Hospice and Palliative Care month, raising awareness regarding increased levels of care for those residents who may be facing life-limiting illnesses. Along with overall comfort, other considerations when it comes to comfort care for our resident include their nutritional status and desires. Residents in the long-term care setting often benefit from individualized diet approaches to maximize their comfort, and this remains especially true for those facing end of life challenges or diagnosis that may impact their oral intakes.
As we age, changes occur to our hunger and thirst sensations, as well as how our body is able to utilize and process nutrients. Ultimately, as patients near the end of life, our bodies are not able to utilize and do not need as much food and fluids as it did before. These decreases in thirst, hunger, efficiency of digestion, and concerns such as weight loss, are common occurrences and likely unavoidable due to natural disease progression at the end of life.
If residents are able to tolerate their diet, special care and consideration should be used to maximize their comfort and meal satisfaction. Favorite foods and beverages, small and/or frequent meals, finger foods, altered textures as needed due to difficulties chewing/swallowing, snacks, food options available 24/7, and supplements as desired, may be appropriate interventions, along with adequate oral cares. Families can also be encouraged to bring in or suggest favorite items to provide for their family members comfort.
During end of life care, family members may become concerned that their loved one is not eating or drinking enough and fear they may be suffering when they experience these hunger and thirst sensation changes. Care should be taken to honor the resident’s hunger and thirst cues as additional food and fluids forced upon them at the end of life may cause adverse symptoms, including:
- Diarrhea or Constipation
- Gastric reflux that can lead to aspiration
It is important to review options for resident comfort, where continuing with end of life/Hospice/Palliative care goals or pursuing artificial nutrition support. If a resident and family decide to pursue artificial nutrition support, consulting with your Registered Dietitian for the most appropriate recommendations, based on their specific goals and considerations for benefits and risks as part of the plan of care. It is important to understand that nutrition support may not increase a resident’s appetite, reverse their current condition, or even promote better quality of life. Often, it is common for a resident to experience adverse effects that can worsen their health status such as:
- Increased risk for infections
While we can not always change the outcome, assisting with a resident’s nutritional status, honoring goals for comfort, and understand the changes they are facing is an important part of care during end of life. Communication with family, all care staff including Hospice/Palliative, and honoring the goals of care is key for the overall benefit to our residents and optimizing their nutritional benefits.
Fuhrman, P. (2018). Nutrition Support at the End of Life: A Critical Decision. Today’s Dietitian. Retrieved from https://www.todaysdietitian.com/newarchives/082508p68.shtml
Dodd, K. (2020, July 30). End of Life Nutrition. Retrieved 2020, from https://www.thegeriatricdietitian.com/embracing-hospice-end-of-life-nutrition/