Understanding the Nutritional Needs of the Dying

Your hospice partner can help you understand the intersection of diet and end-of-life care.

In the U.S., we often think of nutrition and diet in the context of a rehabilitation, health, or wellness plan. In acute or post-acute healthcare settings, nutrition often supports goals that maximize or maintain a level of ability. It may do this through a vitamin or supplement (Ensure or similar drinks, for example), or to ease the effects of a serious or chronic illness (lowering salt intake to ease blood pressure in a patient with CHF).

What might be surprising is that nutrition expertise has a critical role to play in end-of-life care as well. Physiological nutrition needs change significantly when a patient is dying, and there can also be psychosocial elements to consider. When considering the needs of a patient with serious or terminal illness, consult with your hospice partner to understand:

• Comfort feeding: While food plays an important role in our daily lives, intake typically declines as the patient enters their last few weeks of life. It is necessary to understand the importance of comfort feeding versus force feeding. Comfort foods are when favorite foods or beverages may be offered in small amounts when and if the patient shows interest in them. The food is not forced for consumption, but rather offered to the patient to provide nostalgia. It should provide sentimental value and feeling of comfort. During end of life, patients generally do not feel a sense of hunger, but offering foods with sentimental value can provide comfort.
• Therapeutic diets: While comfort care is the focus during hospice, this looks different for each patient as it pertains to oral intake. For example, a patient experiencing congestive heart failure with fluid retention may express the desire to continue following a low-sodium diet with a fluid restriction in efforts to minimize edema and discomfort. If a therapeutic diet is needed, a registered dietitian can offer diet education to the family and caretaker to help achieve patient comfort.
• Tube feeding: There can sometimes be professional ethical concerns surrounding tube feedings, and the patient and family may have different goals. Patients may experience discomfort with tube feedings, while families may feel the withdrawal of such tubes as hastening death. It is important to have open conversations regarding the patient’s end-of-life wishes, life sustaining wishes, and what to expect from tube feeding during the dying process. If a patient is receiving artificial nutrition, a registered hospice dietitian can provide education regarding tube feeding administration, frequency/regimen and help a patient or family understand the costs and benefits of tube feeding.

Our short video can help patients and families understand what to expect at the end of life

Creating a Nutrition Plan of Care

As a patient pivots from curative therapies to comfort treatments near the end of life, a nutrition plan of care takes into consideration a patient’s end-of-life wishes, family and caregiver concerns, and the overall medical status of the patient. Registered dietitians can provide expertise on any of the following:

• Tube feedings
• Parenteral nutrition
• Wound care
• Dysphagia
• Therapeutic diets
• Diet texture modifications
• Cultural diet preferences
• Malnutrition

As a patient progresses on their end-of-life journey, their nutrition goals will change. This may include withdrawing oral nutrition supplementation, decreasing a tube feeding, pureeing food, or offering only comfort foods. Your registered dietitian–as part of the patient’s overall care team–can help set goals for comfort as it relates to nutrition and will continue to help the patient as the goals change.

If you have questions about hospice and how it can support your patients and communities with proper nutrition plans as well as pain management and emotional support, please reach out.