Food Service & Nutrition - Volume 1 No.2 - 16
Constipation is common symptom experienced by patients and if not caused by
medications then traditional methods to
cope with constipation apply and include:
* Drinking 9 to 12 cups of fluids per day.
* Choose bran muffins, whole grains and
cereals (>4 g/svg), add one to two tablespoons of ground flax seed to foods
such as hot cereal or yogurt.
* Eat the skins and seeds of fruits and
vegetables if possible (unpeeled apples,
berries, peppers, snap peas).
* Increase fibre slowly and be sure to consume adequate fluids simultaneously.
* Avoiding milk and dairy products is
not necessary; it is a myth that they
ANOREXIA AND CACHEXIA
No medications effectively treat anorexia
and cachexia, near the end of life,
although some can transiently improve
appetite and energy. The evidence from
clinical studies does not support the use
of artificial hydration or nutrition to
improve symptoms of dehydration, quality of life, or survival in patients at the
end of life. Instead, the focus shifts to
incorporating: food preferences; comfort
foods; small frequent meals; high kcal
foods; addition of supplements; and if
difficulty chewing and swallowing are of
concern, then adaptation of consistency
may be needed. While food should be
offered and if necessary, fed to patients,
it should not be forced upon them.
The cause of delirium is often multifactorial. There is limited evidence to
guide the management of delirium in
the terminal phase of life but strategies that may be helpful in the dining
* Reduction in noise and/or other stimulating environmental factors.
* Eat facing a window, at a table with
limited tablemates or on the unit versus in a dining room.
* Incorporate flexible meal times or rethink and adapt feeding routines.
* Provide time to complete meals.
Care is important
because management of
becomes a primary focus
near the end-of-life.
Comfort foods are defined as foods that
provide feelings of nostalgia, consolation
or a feeling of well-being. Often they are
characterized by a high carbohydrate
and caloric level and simple preparation.
As well, they tend to be favourite foods
Through studies we know that a good
diet in your later years reduces your
risk of osteoporosis, high blood pressure, heart disease and certain cancers.
Although a healthy diet is promoted at
all stages of life, a recent project by the
Institute for Healthcare Improvement
found that "comfort food" inspired
changes in meal options, improved
satisfaction and resulted in better
nutrition. Studies also show that providing comfort foods and oral hydration are perceived as being beneficial
by patients. This is due in part to how
we think about and relate to food. Food
can serve many needs and purposes:
physical; nurturing; traditional; social;
and psychological. However, as disease
advances food tends to represent hope,
comfort and pleasure. As long as food
is pleasurable then the addition of
comfort foods can aid with quality of
life. Using a practical approach, suggestions for incorporating comfort foods
include: consider individual preferences;
try a la carte meals; focus on appealing presentation; consider personalized
portions; adapt the consistency; and
Overall, it is important to remember
that dying is a normal process. The dying
CA N A D I A N S O C I E T Y O F N U T R I T I O N M A N AG E M E N T
process is characterized by diminished
oral intake, progressive fluid deficits,
and progressive accumulation of drugs
(including opioids) and their metabolites,
which can cause new symptoms or exacerbate existing ones. This in turn leads
to a further decline in the individual's
ability to obtain and/or consume food
or fluids. During this process, patients
have diminished awareness, which may
decrease their perception of thirst and
hunger as they naturally progress toward
coma and death. In a study that looked
at the frequency of symptoms of hunger
and thirst in a group of terminally ill
patients, they found that 63 per cent
never experienced any hunger, while
34 per cent had symptoms only initially.
Likewise, 62 per cent experienced either
no thirst or thirst only initially during
their illness. In all patients, symptoms of
hunger could be alleviated and relative
comfort experienced even with small
amounts of food. Further, complaints of
thirst or dry mouth were relieved with
mouth care (cleansing, swabbing), small
sips of fluids, hard candies and/or by the
application of ice chips and lubrication
to the lips.
While everyone stops eating and
drinking at some point prior to death,
voluntary cessation with the intent of
hastening death is unusual. If the patient
is able, continue to offer and encourage
oral intake if it is compatible with the
overall goals of care and comfort. As well,
providing choice, assistance and time to
complete meals, selecting food that has
taste and appropriate consistency, liberalizing therapeutic diets, offering comfort foods, varying the size and frequency
of the meals and avoiding distractions
while eating, are all great strategies of
support and will enhance an individual's
quality of life.
Andrea LeBel is a Clinical
Dietitian at Carewest
Glenmore Park. She is
responsible for providing
nutrition support to clients
in order to promote health and healing.