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Nutrition and Hydration A Palliative Approach to Care

Nutrition and Hydration A Palliative Approach to Care

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Page 1: Nutrition and Hydration A Palliative Approach to Care

Nutrition and Hydration

A Palliative Approach to Care

Page 2: Nutrition and Hydration A Palliative Approach to Care

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

Page 3: Nutrition and Hydration A Palliative Approach to Care

Holistic Aspects of Nutrition

• Physiological

• Social – sharing meals

• Personal taste preferences

• Cultural food preferences

Page 4: Nutrition and Hydration A Palliative Approach to Care

Nutrition

• Most common nutritional problems for residents in RACF are

– Weight loss

– Associated protein energy malnutrition

– Depression

– Adverse medication side effects

Page 5: Nutrition and Hydration A Palliative Approach to Care

Nutrition • Factors affecting poor nutritional status

– Advanced dementia

– Apathy

– Fatigue

– Paranoid behaviour

• Assessment for dysphagia important to provide direction for oral feeding

Page 6: Nutrition and Hydration A Palliative Approach to Care

Potentially reversible causes• Metabolic disorders such as thyroidism

• Chronic infections

• Alcoholism (nutrient malabsorption)

• Oral health factors

• Use of therapeutic diets

• Vitamin deficiencies

Page 7: Nutrition and Hydration A Palliative Approach to Care

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

Page 8: Nutrition and Hydration A Palliative Approach to Care

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

Page 9: Nutrition and Hydration A Palliative Approach to Care

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

Page 10: Nutrition and Hydration A Palliative Approach to Care

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

Page 11: Nutrition and Hydration A Palliative Approach to Care

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

Page 12: Nutrition and Hydration A Palliative Approach to Care

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

Page 13: Nutrition and Hydration A Palliative Approach to Care

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

Page 14: Nutrition and Hydration A Palliative Approach to Care

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