Food Service & Nutrition - Volume 1 No.2 - 15


palliative care, the goals of nutritional
care change with disease progression. The
emphasis tends to focus on quality of life
(QOL), energy maintenance, prevention
of weight loss and symptom relief rather
than active nutritional therapy. In conjunction with the above, respecting the
individual's wishes regarding nutrition
and hydration is supported.
Recent research on the nutrition preferences of long term care residents (prior to
reaching a palliative care level) revealed
that selecting a food choice that aided
in the management of a nutrition-related
health condition came second to selecting
preferred foods. Of study participants,
52 per cent report they would accept a
texture modified diet, compared to 28 per
cent who would accept a therapeutic diet
modification (i.e. Low Sodium, Low Fat).
The research also revealed that residents
want to make choices from a variety of
options (including those patients on texture modified diets). Overall, it is important that menus provide choice, offer
foods that are likely to be eaten and offer
foods that are palatable to reduce the risk
of malnutrition. Liberalizing therapeutic
diets in the elderly can aid with energy
maintenance and weight loss prevention by promoting meal satisfaction and
adequate intake while optimizing QOL.
A large component of comfort nutrition
is related to symptom relief. When looking at providing medical care towards the
end-of-life, the Comfort Care approach
is widely used. This is the set of palliative care interventions that provide relief
of symptoms in a patient who is dying.
Symptoms with a nutritional component
include: pain; coughing; xerostomia or
dry mouth; nausea and vomiting; constipation; anorexia and cachexia (wasting of
the body); and delirium. Understanding
Comfort Care is important because management of distressing symptoms becomes
a primary focus near the end-of-life.
PAIN AND COUGHING
When we look at pain, the evidence-based
management of it is via the use of opioid
medications. While not everyone experiences pain, it is easier to prevent than

As clients move toward
palliative care, the goals
of nutritional care change
with disease progression.

to relieve, and extreme pain is difficult
to manage. Therefore, the focus tends be
on relieving pain without worrying about
possible long-term problems or dependence of drug use.
Coughing occurs at the end of life
and has been reported in 60 per cent to
nearly 100 per cent of dying patients with
various nonmalignant diseases. Opioids,
which act centrally to suppress the cough
centre, have been shown to be effective
antitussive agents at low doses. However,
constipation is a frequent side effect of
opioid therapy and is known as Opioid
Induced Constipation (OIC). OIC should be
anticipated and treated prophylactically,
not by increasing fibre intake as this may
make it worse due to decreased intestinal
motility that results from narcotic use.
XEROSTOMIA
Xerostomia, or dry mouth, is a common
issue among patients at the end of life.
Some of the causes include medications
(opioids) and dehydration. Strategies to
minimize dry mouth include the discontinuation of unnecessary treatment with
drugs that may contribute to the problem and the use of saliva stimulants or
substitutes. Nutritional tips to help with
the management of dry mouth include:
* Eat crunchy vegetables. These foods
need chewing which stimulates the
flow of saliva.
* Chew sugar-free gum or suck on ice
chips, sugar-free sour candies or a
sugar-free popsicle.
* Use gravies, salad dressings and mayonnaise to moisten foods.
* Include broth or soup at lunch and supper to dip or soak foods in.

* Sip on juices and other fluids throughout the day but avoid drinks with caffeine as these can make a dry mouth
feel worse.
Hydration's role in the dying process
has been debated. Fear of making patients
uncomfortable due to thirst encourages
clinicians and families to provide fluids
to patients when oral intake is declining.
Small studies have suggested that fluids
play a minimal role in patient comfort as
long as mouth care is provided, small sips
of fluid are given, and application of ice
chips, lip balm, and moistened swabs to
the lips occurs.
NAUSEA AND VOMITING
Most episodes of nausea and vomiting near
the end of life have multifactorial causes but
common ones include reactions to opioids
and other medications, bowel obstruction
and gastroparesis (lack of stomach motility).
Nutritional tips to help with the management of Nausea and Vomiting include:
Nausea
* Eat small, lower fat meals and snacks
throughout the day. These are digested
more easily and pass through your
stomach faster.
* Choose your favourite foods more often.
* If the aroma of hot foods is bothersome,
eat foods at room temperature.
* Use straws for drinks and nutritional
supplements.
* Drink liquids between meals, not
with meals.
* Relax after you eat and sit up to help
the food digest. Try not to lie down for
at least two hours after eating.
* Eat dry crackers or toast before you get
out of bed in the morning.
* Do not force yourself to eat.
* Suck on ice cubes or popsicles.
Vomiting
* Avoid drinking fluids for at least 30
minutes after vomiting.
* Try small sips of water or clear fluids
(broth, gelatin, popsicles, juice).
* If fluids are tolerated, Introduce bland
foods (crackers, graham wafers, hot
cereal, mashed potatoes) first.

F O O D S E RV I C E & N U T R I T I O N

15



Table of Contents for the Digital Edition of Food Service & Nutrition - Volume 1 No.2

President’s Message
Malnutrition: Becoming Food Aware
Food Service Systems Management
Clinical Nutrition Competency
CSNM Corporate Member Profile
Ask an Expert
Advertiser Index
Management Notebook
Industry & CSNM News
Continuing Education Quizzes
Advertiser Index
Food Service & Nutrition - Volume 1 No.2 - cover1
Food Service & Nutrition - Volume 1 No.2 - cover2
Food Service & Nutrition - Volume 1 No.2 - 3
Food Service & Nutrition - Volume 1 No.2 - President’s Message
Food Service & Nutrition - Volume 1 No.2 - Malnutrition: Becoming Food Aware
Food Service & Nutrition - Volume 1 No.2 - 6
Food Service & Nutrition - Volume 1 No.2 - 7
Food Service & Nutrition - Volume 1 No.2 - 8
Food Service & Nutrition - Volume 1 No.2 - 9
Food Service & Nutrition - Volume 1 No.2 - Food Service Systems Management
Food Service & Nutrition - Volume 1 No.2 - 11
Food Service & Nutrition - Volume 1 No.2 - 12
Food Service & Nutrition - Volume 1 No.2 - 13
Food Service & Nutrition - Volume 1 No.2 - Clinical Nutrition Competency
Food Service & Nutrition - Volume 1 No.2 - 15
Food Service & Nutrition - Volume 1 No.2 - 16
Food Service & Nutrition - Volume 1 No.2 - CSNM Corporate Member Profile
Food Service & Nutrition - Volume 1 No.2 - 18
Food Service & Nutrition - Volume 1 No.2 - Ask an Expert
Food Service & Nutrition - Volume 1 No.2 - Advertiser Index
Food Service & Nutrition - Volume 1 No.2 - Management Notebook
Food Service & Nutrition - Volume 1 No.2 - 22
Food Service & Nutrition - Volume 1 No.2 - Industry & CSNM News
Food Service & Nutrition - Volume 1 No.2 - 24
Food Service & Nutrition - Volume 1 No.2 - 25
Food Service & Nutrition - Volume 1 No.2 - Continuing Education Quizzes
Food Service & Nutrition - Volume 1 No.2 - Advertiser Index
Food Service & Nutrition - Volume 1 No.2 - cover4
Food Service & Nutrition - Volume 1 No.2 - outserts1
Food Service & Nutrition - Volume 1 No.2 - outserts2
Food Service & Nutrition - Volume 1 No.2 - outserts3
Food Service & Nutrition - Volume 1 No.2 - outserts4
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