What is the role of the Registered Dietitian?
Registered dietitians (RDs) work collaboratively to make nutrition, hydration, and feeding recommendations. RDs assess patients’ nutritional needs, offer nutritional counseling, and provide meals that reduce constipation and other side effects of medication and treatment. Dietitians also encourage patients and families to suggest or supply their own favorite meals such as mom’s home-cooked chicken or dad’s special cake. People will generally eat more if they can eat familiar favorites and those they regard as comfort foods. RDs also help educate patients and their families about end of life care choices. RDs are a valuable asset to an institution’s ethics committee. When facing difficult decisions it is often reassuring for families to hear similar messages from multiple care team members. Often the RDs familiarity with practical aspects of food and fluid at the end of life including chewing and swallowing problems and cessation of thirst and hunger make them best able to address families’ concerns and answer questions. RDs may find that they need to answer the same question many times. The complexity of the issue demands that topics be approached and sorted through from multiple perspectives, always assuring that consistent answers are provided so that patients and their families feel secure in making sensitive end of life food and fluid decisions. Peaceful Hope Hospice And Palliative Care proudly serves Dietary Counseling in Dallas, Texas and the surrounding areas.
What is the role of food and fluids at the end of life?
The importance of food and nutrition at the end of life
In the last stages of the dying process, the purpose of food is enjoyed more than nutrition. One dying patient in a nursing facility was referred to the dietitian because she requested a rum and coke from the hospice team. Her physician refused to provide an order. To meet the needs of the patient and to satisfy the physician, the dietitian used rum extract in the coke. The patient enjoyed the taste and the physician was satisfied.
Too much food and fluids can impose a physiological burden and negatively impact palliative care at the end of life. Food is the fuel that the body needs to restore energy and rebuild body tissues. When the body is no longer repairing and restoring, the amount of food needed is sharply decreased.
Nutrition related palliative care
Patient choice and informed decisions are of the utmost importance. Though it is important to identify malnutrition in palliative care, reversing that malnutrition may not be possible for the patient at the end of life. Traditional nutrition goals shift to be more in line with the overall philosophy of palliative care. The education provided to healthcare professionals when appetite is an issue is to either offer between meal nourishments or to provide frequent, small feedings. In the case of the dying patient, neither may be appropriate. Supplements are most often liquid and may deprive the patient of various textures and tastes but are appreciated by many patients and caregivers. Family caregivers have been known to unnecessarily awaken a sleeping patient so that they can fit in the recommended number of small meals. When a patient is pressured to eat, family friction and distress may result. It is important to serve foods requested by the patient and to provide it in small portions. Some cognitively intact patients may refuse food and fluids; this decision must be respected.
Artificial nutrition and hydration
Artificial nutrition is defined as the provision of fluids through an intravenous access to a vein. The healthcare professional has the obligation to inform and support those making the decision about artificial nutrition and hydration. The ethical matters involved in these decisions include the person’s right to refuse any unwanted medical interventions and the requirement that the healthcare professional tells the truth to the patient and do no harm.
Stopping foods and fluids at the end-of-life
A 2003 study published in the New England Journal of Medicine surveyed 307 hospice nurses (3). Overall, the nurses rated quality of death of those patients who refused food and fluids at the end-of-life good, with an average score of 7 on a scale of 0-9 where 0 is ‘a very bad death’ and 9 is ‘a very good death.’ According to the nurses, the most important factor in stopping food and fluids is the patient’s readiness to die.
Peaceful Hope Hospice and Palliative Care believes that each individual should be healthy and maintain a healthy diet, especially the aging adults. That is why we offer this service with the main goal of helping patients improve and achieve a healthy lifestyle through dietary counseling.
Our dietary counseling services include:
- Personal assessment
- Diet plan
- Diet monitoring
- Nutrition counseling