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Nutrition

What we know

Food and nutrition has a social value as well as a nutritional value to people. As people come to the end of their life they may have less interest in food and there may be physical issues to be considered such as swallowing difficulties and fatigue. Families may also be concerned about weight loss.

What can I do?

A family conference with relevant care staff, health professionals and the family can be useful early on to discuss what might be expected with regard to reduced oral intake and appetite as health deteriorates. You can help plan for how this will be managed and understand individual and family preferences. The PA Toolkit has an invitation and question resource (183kb pdf) for a family meeting.

Early family counselling with a dietitian can offer strategies for changes in appetite or food textures to maximise enjoyment and nutritional intake. You can direct family to the APD website to find a dietitian in their area – just enter their postcode and search.

When eating and drinking is no longer possible, remind the family they can continue to care with activities such as mouth care.

 

What can I learn?

Short case studies and worksheets regarding helping people with reduced hydration and nutrition are available.
 
Palliative Approach Toolkit - Module 3 Clinical care (2012) (2.81MB pdf). Section 3 covers Nutrition and Hydration issues in aged care.

The Hospice and Palliative Nurses Association (HPNA) (US) has a position statement on Artificial nutrition and hydration in advanced illness (2011). They also have an information sheet: Changes in Hydration in the Final Days (2013).

Presentation from ESPEN conference - Nutritional Management in Palliative Care (2003).

Are you managing older adults from different multicultural backgrounds - you may like to read up on how their attitudes towards death and dying may influence their care preferences for a loved one.
 

 

What can my organisation do?

Malnutrition screening may be useful in identifying people requiring nutrition support - easy to administer tools are widely available and can be linked with a malnutrition action plan (MUST (896kb pdf) / MNA short form - elderly (69kb pdf)).


At end of life, obtaining regular weights (kg) and attempting to achieve weight gain is not a priority for palliative care patients and may be distressing to both the patient and the family - **in a residential aged care setting it may be necessary to discontinue weekly / fortnightly / monthly weighs.

Good oral hygiene is an important part of eating; all people receiving palliative care should receive regular 'mouth checks' to determine if any problems with a tooth, denture, or gum could impair the ability to eat or drink or to enjoy food.
  • Consider helping re-direct the family in supporting the patient with activities such as mouth care when nutrition support is withdrawn or not viable.

Useful links:

  1. Video - ‘The Role of the Dietitian'.

Further learning:

  1. Presentation from ESPEN conference – Nutritional Management in Palliative Care (2003) (339kb pdf).
Page updated 22 May 2017