Understanding the Nutritional Needs of the Dying

The Academy of Nutrition and Dietetics celebrates March as National Nutrition Month® and recognizes registered dietitians as medical nutrition therapy experts. In hospice care, each patient has a unique story, and this is also true when it comes to their nutritional needs.

As an integral part of the patient care team, registered dietitians develop an individualized nutrition care plan and play a vital role in explaining the options and outcomes to the patient and caregiver.

Honoring a loved one’s cues for nutrition, 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 provide expertise on tube feedings, parenteral nutrition, wound care, dysphagia, therapeutic diets, diet texture modifications, cultural diet preferences, and malnutrition.

As a patient progresses on their hospice journey, their nutrition goals of course will change. This may include withdrawing oral nutrition supplementation, decreasing or withholding 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 and family as the patient continues his/her journey.

A dietitian provides appropriate resources to patient, family and team. This can include suggestions and direction on:

• Comfort feeding: While food plays an important role in our daily lives, intake typically declines during end 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. Patients generally do not feel the sense of hunger but offering foods with sentimental value can provide comfort during end of life.
• Texture modifications: Depending on the patient’s medical history, they may require texture modifications of their diet to safely consume food and beverages. In these situations, texture modification is encouraged to help maintain a safe feeding environment and reduce the risk of choking or aspiration. It may be recommended to mince food items for easier chewing or thicken beverages for a safer swallow.
• Therapeutic diets: While comfort care is our 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 your registered dietitian can offer diet education to the caretaker to help achieve patient comfort.
• Tube feeding: There are often ethical concerns surrounding tube feedings. It is important to have open conversations regarding the patient end of life wishes, life sustaining wishes, and what to expect from the tube feeding during the dying process. If a patient is receiving artificial nutrition, the registered dietitian is available to provide education regarding tube feeding administration, tube feeding frequency/regimen and ongoing support with any concerns surrounding the tube feeding.
• Wound care: Nutrition plays an important role in skin integrity. Optimizing nutritional intake when a wound is present can help promote wound healing or prevent further deterioration. Your registered dietitian will assess if and what nutrition interventions may be beneficial.

The objective for the patient is to honor life and offer hope and doing this through nutrition is possible. With March as National Nutrition Month® as a backdrop, it is a reminder that AccentCare’s team of compassionate registered dietitians work hard with the patient and caregiver to ensure that a loved one is provided proper nutrition care during their hospice journey.

Please reach out to your AccentCare team to connect with your registered dietitian to learn more about how they can assist you and your loved one on their journey.