Palliative Care Challenges: Offering Supportive Nutritional Care at End of Life

By Mary Ellen Posthauer RDN, CD, LD, FAND

Food is a major part of our lives with strong emotional and symbolic implications that encompasses nurturing, cultural, religion, tradition and social values. Nutrition and hydration has an effective role in healing wounds, but cannot prevent an individual with co-morbid conditions at the end of life from suffering or imminent death. This concept is often difficult to explain to the individual and especially to the caregivers who view nutrition and hydration as essential for life.

The goal of palliative care is offering comfort rather than curing, while improving the quality of living and dying for those near the end of life. Clinicians should strive to maintain adequate nutrition and hydration that is compatible with individual’s condition and wishes. As a member of the health care team, the dietitian should be involved in assessing the individual’s nutritional needs and educating the family/caregiver on nutrition expectations at the end of life.

Education and communication with families dealing with palliative care decisions is key to achieving a positive outcome of comfort and dignity for the individual. Practitioners should be sensitive to the cultural and/or religious beliefs that may influence how the individual or family views end of life. Family/caregiver interaction and socialization should be supported which offers an actual or illusionary source of strength, comfort and caring for the individual.

One of the many challenges facing dietetics practitioners is meeting the nutrition and hydration needs of the individual receiving palliative care. If the individual is alert and able to tolerate food and fluid, the following suggestions are recommended:

• Offer smaller meals of preferred food/fluid, regardless of the nutritional value
• Relax/liberalize therapeutic diets (diabetic, sodium restricted, etc.) ordered to treat a medical condition
• Explain to family/caregiver the rationale for liberalizing diet restrictions
• Provide supplements of choice, if desired or tolerated
• Keep water or fluid of choice at the bedside in a thermal container and encourage small, frequent sips
• Avoid highly seasoned foods, unless requested
• Offer comfort foods, gelatin, ice cream, popsicles, soups, and ginger ale (may help with nausea)
• Educate the caregiver on appropriate feeding techniques (small bites or sips, never force feed or feed an individual who is not alert or awake)
• Explain the dangers associated with choking or aspiration of food or fluid
• Educate the caregiver about food safety issues (e.g. Once opened, commercial supplements are perishable and should be chilled and discarded appropriately; wash raw vegetable or fruits prior to serving; keep serving area clean; discard uneaten food promptly, etc.)

When end of life is imminent, explain to the caregiver the benefit of lack of fluids or dehydration for the individual. Dehydration at end of life produces a natural anesthetic effect, decreases the awareness, reduces urine output and may decrease pain. All palliative care interventions should reflect the individual’s choices and desires with the goal to retain their comfort and highest quality of life possible.

Sources:
2009 NPUAP-EPUAP Pressure Ulcer Prevention and Treatment Guidelines, www.NPUAP.org.

About The Author
Mary Ellen Posthauer RDN, CD, LD, FAND is an award winning dietitian, consultant for MEP Healthcare Dietary Services, published author, and member of the Purdue University Hall of Fame, Department of Foods and Nutrition, having held positions on numerous boards and panels including the National Pressure Ulcer Panel and the American Dietetic Association’s Unintentional Weight Loss work group.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.