Understanding End-Of-Life Nutrition And Hydration

Navigating nutrition and hydration during palliative care can be a challenging and nuanced aspect of supporting individuals facing serious illnesses. As loved ones and caregivers seek to provide the best possible comfort and quality of life, understanding the role of nutrition and hydration becomes essential. We discuss the importance of proper nutrition and hydration in palliative care, exploring how tailored dietary strategies can enhance well-being, manage symptoms, and offer dignity and comfort during a difficult time.

To begin, let’s untangle a common misconception: the conflation of palliative care with end-of-life care. While these terms are frequently lumped together, there are distinct differences.

Palliative care focuses on improving the quality of life for individuals facing serious illnesses by addressing their physical, emotional, and spiritual needs. It can be provided alongside curative treatment and is not limited to individuals in the terminal stages of their illness. Palliative care aims to alleviate symptoms, manage pain, and enhance overall well-being.

End-of-life care, on the other hand, specifically refers to the care provided to individuals who are nearing the end of their life, typically within the last few weeks of life. It focuses on ensuring comfort, dignity, and quality of life for patients who are no longer pursuing curative treatment. End-of-life care may involve symptom management, emotional support, assistance with advance care planning, and facilitating a peaceful and dignified death.

The Importance Of Good Nutrition

Good nutrition plays a crucial role in palliative care, which focuses on improving the quality of life for individuals facing serious illnesses and relieving their symptoms, rather than curing the underlying disease. Here are several reasons why good nutrition is important in palliative care:

Maintaining strength and energy levels: Proper nutrition provides the body with essential nutrients, calories, and fluids necessary to maintain strength and energy levels. This is particularly important for individuals undergoing palliative care who may experience fatigue and weakness due to their illness and treatments.
Supporting immune function: A well-balanced diet supports immune function to help prevent infections and reduce the risk of complications, which is especially crucial for individuals with weakened immune systems due to illness or treatment.
Managing symptoms: Certain symptoms common in palliative care, such as nausea, vomiting, constipation, and loss of appetite, can significantly impact a person’s ability to maintain adequate nutrition. Tailoring the diet to address these symptoms, such as offering small, frequent meals, incorporating foods that are easy to digest, or using supplements as needed can help manage these symptoms and improve overall comfort.
Enhancing quality of life: Good nutrition can contribute to a better quality of life by improving overall well-being, mood, and cognitive function. Enjoying favourite foods or meals can bring comfort and pleasure to individuals undergoing palliative care, contributing to their emotional and psychological well-being.
Supporting tissue repair and wound healing: Adequate protein intake is essential for tissue repair and wound healing, particularly for individuals with advanced illnesses who may have wounds or pressure ulcers. Including protein-rich foods in the diet can help support these processes and prevent further complications.
Providing comfort and dignity: Sharing meals and food rituals with loved ones can provide comfort, social support, and a sense of normalcy for individuals in palliative care. It also allows them to maintain a sense of dignity and autonomy by participating in decision-making regarding their food preferences and choices.

Overall, good nutrition is an integral part of holistic palliative care, helping to optimise physical, emotional, and social well-being for individuals facing serious illnesses, and improving their overall quality of life during what can be a very challenging time.

Bear Brady, Lifestyle Lead at our Albany Lodge Care Home, adds:

“As a caregiver in the context of palliative care, the primary goal is to respect the individual’s wishes and preferences while ensuring their comfort and dignity. While we strive to maintain a semblance of familiarity and comfort by offering foods and drinks that they’ve always enjoyed, we do so with a deep understanding that each person’s journey is unique. Some may eagerly partake, while others may find their appetite waning as they near the end of life. Regardless of the scenario, our commitment to honouring their choices and preferences with utmost respect remains unwavering. Ultimately, in the final weeks, if someone decides against eating or drinking or finds themselves unable to do so, we embrace this decision wholeheartedly. It’s essential to honour their autonomy and choices.

Encouraging someone to eat or drink against their wishes could lead to discomfort, distress, or even aspiration, particularly if they have difficulty swallowing or have lost their appetite due to their illness. Instead, we focus on providing alternative methods of comfort and support, such as mouth care, moistening the lips, or offering small sips of water if the individual desires.

It’s crucial to have open and honest communication with the individual and their family members or caregivers about their preferences regarding eating and drinking. In some cases, they may choose to continue eating and drinking as long as they are able, while others may naturally lose their appetite as part of the end-of-life process.

Ultimately, our role as the caregiver is to provide compassionate support and ensure the individual’s comfort, respecting their autonomy and dignity throughout the end-of-life journey. This may involve addressing other sources of distress or discomfort, such as pain, shortness of breath, or emotional distress, rather than focusing solely on food and fluids.”

Key Issues In Palliative Care Nutrition

In palliative care and end-of-life care, nutrition poses several key challenges and considerations that need to be addressed to ensure the comfort and well-being of the individual:

Appetite and dietary changes: Individuals nearing the end of life often experience changes in appetite, taste perception, and dietary preferences. They may lose interest in food altogether or have difficulty swallowing, leading to reduced food intake. Caregivers need to be sensitive to these changes and adapt the diet accordingly to provide nourishment that is both appealing and manageable.
Nutritional requirements: Meeting the nutritional needs of individuals in palliative care can be complex. While maintaining adequate intake of essential nutrients is important, the focus shifts from achieving nutritional goals to optimising comfort and quality of life. Caregivers may need to prioritise certain nutrients, such as protein and fluids, to support tissue repair and hydration, while being mindful of individual preferences and tolerances.
Symptom management: Symptoms such as nausea, vomiting, constipation, and pain can significantly impact a person’s ability to eat and drink. Addressing these symptoms effectively is crucial for maintaining appetite and promoting intake. This may involve medication management, dietary modifications, and non-pharmacological interventions to alleviate discomfort and improve overall well-being.
Cultural and religious considerations: Cultural and religious beliefs often influence dietary preferences and practices, especially in the context of end-of-life care. Caregivers should be sensitive to these factors and respect the individual’s cultural and spiritual values when planning and providing meals.
Hydration: Ensuring adequate hydration is essential for comfort and preventing dehydration, particularly in individuals with advanced illnesses. However, the approach to hydration varies depending on the individual’s condition and preferences. While some may benefit from oral fluids or hydration through intravenous or subcutaneous routes, others may naturally reduce their fluid intake as part of the dying process. Caregivers must assess hydration status regularly and tailor interventions accordingly.
Emotional and psychosocial aspects: Food can carry significant emotional and social significance, evoking memories, comfort, and connection with loved ones. Caregivers should recognise the emotional and psychosocial dimensions of food and meals by fostering a supportive environment that honours these aspects and promotes dignity and well-being.

Addressing these key issues requires a multidisciplinary approach involving healthcare professionals, nutritionists, caregivers, and family members working together to provide personalised and compassionate care tailored to the individual’s needs and preferences.

Optimising end-Of-Life Nutrition At The Future Care Group

Bespoke end-of-life care planning is a crucial component of a resident’s introduction into our care. We carefully and sympathetically have those discussions around how a resident wants their journey to conclude and we rely on our end-of-life values to guide us through the process.

Tailoring end-of-life care for residents in a care home involves a deeply empathetic and personalised approach, especially when it comes to addressing their nutritional needs and preferences. Across the Future Care Group homes, bespoke End-of-life care planning is fundamental to each resident’s journey, ensuring that their wishes are respected and upheld with sensitivity and compassion.

When a resident enters our care, we initiate discussions with them and their families regarding their preferences for end-of-life care whilst upholding our fundamental end-of-life values. These conversations are pivotal in understanding their desires and crafting a tailored plan that honours their wishes. We recognise the importance of involving families in this process, acknowledging their integral role in their loved one’s journey.

Brady tells us:

“As the journey progresses, it’s common for residents to experience a decrease in appetite. To address this, our in-house chefs diligently prepare a range of options tailored to individual needs, including supplements and fortified drinks to ensure residents receive adequate nutrition and hydration. Understanding that each resident’s dietary requirements may vary, our chefs are adept at catering to all levels of the International Dysphagia Diet Standardisation Initiative (IDDSI), as well as providing fortified foods and fluids for those with specific needs identified by the Speech and Language Therapy (SALT) team.

Building close relationships with residents is essential for our chefs as it enables them to understand preferences and adapt menus accordingly. For some residents, particularly those nearing the end of life, a shift towards sweeter foods and desserts may be preferred, and our chef ensures these options are readily available. Additionally, as residents may reach a stage where they are unable to consume solid foods, we offer alternatives such as fortified liquids and use innovative methods like administering oil on sponges to prevent mouth dryness.

Recognising the potential effects of dehydration at end of life, we prioritise hydration management to alleviate discomfort. While dehydration may have a paradoxical effect of dulling sensations and reducing pain for some individuals, we remain vigilant in ensuring adequate hydration to promote comfort and well-being.

Our approach to catering for palliative and end-of-life residents goes beyond sustenance. It embodies a commitment to dignity, respect, and individualised care, ensuring each resident’s journey is supported with warmth, understanding, and culinary expertise”.

If you would like more information on our end-of-life care provision, you can either contact us online, or call us direct on 02045 862 548 and speak to a member of our very friendly staff. Alternatively, why not book a visit to one of our eighteen homes and see our award-winning carers in action firsthand.