Nutrition and Hydration A Palliative Approach to Care.
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Transcript of Nutrition and Hydration A Palliative Approach to Care.
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
Holistic Aspects of Nutrition
• Physiological
• Social – sharing meals
• Personal taste preferences
• Cultural food preferences
Nutrition
• Most common nutritional problems for residents in RACF are
– Weight loss
– Associated protein energy malnutrition
– Depression
– Adverse medication side effects
Nutrition • Factors affecting poor nutritional status
– Advanced dementia
– Apathy
– Fatigue
– Paranoid behaviour
• Assessment for dysphagia important to provide direction for oral feeding
Potentially reversible causes• Metabolic disorders such as thyroidism
• Chronic infections
• Alcoholism (nutrient malabsorption)
• Oral health factors
• Use of therapeutic diets
• Vitamin deficiencies
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
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
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
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
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
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
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
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