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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

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nutrition and hydration

Nutrition and Hydration

A Palliative Approach to Care

nutrition hydration
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
Holistic Aspects of Nutrition
  • Physiological
  • Social – sharing meals
  • Personal taste preferences
  • Cultural food preferences
nutrition
Nutrition
  • Most common nutritional problems for residents in RACF are
    • Weight loss
    • Associated protein energy malnutrition
    • Depression
    • Adverse medication side effects
nutrition1
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
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
  • 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
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
  • 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
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 hydration1
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
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
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
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
ad