Nutrition and Hydration

1. Nutrition and Hydration A Palliative Approach to Care

2. Nutrition & Hydration • Nutrition and hydration issues for residents receiving a palliative approach involve ethical decision making for the aged care team, resident and family members • Nutritional intake of residents in RACF is a clinical and quality of life issue

3. Holistic Aspects of Nutrition • Physiological • Social – sharing meals • Personal taste preferences • Cultural food preferences

4. Nutrition • Most common nutritional problems for residents in RACF are • Weight loss • Associated protein energy malnutrition • Depression • Adverse medication side effects

5. Nutrition • Factors affecting poor nutritional status • Advanced dementia • Apathy • Fatigue • Paranoid behaviour • Assessment for dysphagia important to provide direction for oral feeding

6. Potentially reversible causes • Metabolic disorders such as thyroidism • Chronic infections • Alcoholism (nutrient malabsorption) • Oral health factors • Use of therapeutic diets • Vitamin deficiencies

7. Oral Nutrition • Oral nutrition rather than nasogastric enteral feeds is best practice management for older persons • Requires diligent hand feeding program • carer assisting with feeding should be seated at eye level with the resident • take time to establish a relationship • create a relaxing atmosphere

8. Nutrition at End-of-life • Eating and drinking may no longer be of interest to the resident entering the end-of-life phase • When interest in food and fluid becomes minimal the individual should not be forced to receive them

9. Artificial hydration • Artificial hydration should be considered in the palliative approach where dehydration results from potentially correctable causes: • over treatment of diuretics and sedation • recurrent vomiting • diarrhoea • hypocalcaemia

10. End-of-life • The provision of artificial nutrition and hydration may be detrimental to the dying person • The desire to feed stems from the belief that dehydration in a person close to death is distressing

11. Artificial Hydration • Adverse effects of fluid accumulation caused by artificial hydration at end-of-life: • increased urinary output • increased fluid in GI tract – vomiting • pulmonary oedema, pneumonia • respiratory tract secretions • ascites

12. Feeding at end-of-life • Continuing PEG feeding at end-of-life may pose a burden on the dying person • Discussion with resident and carers to review benefits against potential burden • Resident’s best interests and preferences guide decision making

13. Tube feeding decision aid • Information on options and outcomes • Steps to decision making that are based on the resident’s preferences, personal values and clinical situation • A documented treatment plan designed to put these steps into operation

14. Summary • Nutrition and hydration issues involve ethical decision making • Assessment and management of treatable causes • Potential for burden at end-of-life • Tube feeding decision aid