Written by: Faith Slater, Tissue Viability Link Nurse at St Wilfrid’s Hospice, Chichester
Having worked in palliative care for many years I have seen first-hand the difficulties of maintaining a patient’s nutrition and hydration at the end of life.
Often symptoms such as pain, nausea and fatigue can impact greatly on the patient’s ability to eat and drink. Not only does this cause weight loss and fatigue but can also impact the social aspects of a patient’s life, potentially leading to social isolation (Marie Curie, 2021). During my time working as a palliative care nurse, we have managed to alleviate many symptoms to enable patients to eat and drink far more than when first admitted. Seeing patients enjoy food again, even the smallest of portions is a joy to see.
There are other ways in which we can increase a patient’s nutritional status such as adapting mealtimes, offering favourite foods, managing symptoms and offering supplements (Leading Nutrition, 2021). It is crucial this is discussed and planned with the patient ensuring their wishes and preferences are at the forefront of the care provided (National Institute for Health and Care Excellence, NICE, 2017).
Clinically assisted nutrition and hydration at end of life is a much-debated subject as there is limited research into the benefits/risks of providing this towards the end of a patient’s life. Hydration and nutrition can be provided with a percutaneous endoscopic gastrostomy (PEG) or radiologically inserted gastrostomy (RIG) feeding tubes through the abdominal wall. In addition, fluids can be given intravenously (IV) or subcutaneously (SC). Using these methods to administer nutrition has to be weighed up carefully incorporating the patient’s wishes but also clinically assessing whether the patient will tolerate such methods as fluid imbalance and aspirating are just some of the potential risks to patients (General Medical Council, GMC, 2021).
As patients move into the end of life, their desire to eat and drink decreases significantly. In my experience patients are not usually distressed by this as the human body is remarkable and naturally decreases the patient’s desire to eat or drink as it prepares for death.
Nonetheless, supporting families in this time is crucial. I have seen many families distraught by their loved one’s loss of appetite. Eating together is often a social time and providing food is a way in which love is shown. Finding other ways for families to show their love can help greatly. Simple things like showing families how to give mouth care provides a role for the family and in addition, helps to keep the patient’s mouth moist and quench any thirst.
In consideration of our patient’s skin, malnutrition can have a detrimental impact. I have seen pressure ulcers on patients of all ages, and this is often linked to poor nutritional status (European Pressure Ulcer Advisory Panel (EPUAP) (2019) in addition to decreased mobility. In end of life, we are limited with what we can do to provide the skin with the protein it needs through diet to repair itself but we can however assess and provide the right equipment, dressings and repositioning care plans to prevent further skin damage.
In end of life care, balancing nutrition and hydration is complex. Each patient has to be assessed on an individual basis, considering their individual wishes and personal preferences. As healthcare professionals we can provide the best possible care by providing individualised holistic support to the patient and supporting and working with their families to ensure clear and concise communication.
We are changing lives every day. We are OSKA – the Pressure Care Experts.
References
General Medical Council (GMC) (2021) ‘Clinically assisted nutrition and hydration’ Available at: Clinically assisted nutrition and hydration – GMC (gmc-uk.org) (Accessed:06/06/21)
(European Pressure Ulcer Advisory Panel (EPUAP) (2019) Available at: PU Guidelines – EPUAP (Accessed:06/06/21)
Leading nutrition (2021) Available At: Dietitian – Aged Care | Leading Nutrition – The Dietitian Centre (Accessed: 06/06/21)
Marie curie (2021) Available at: Patient hydration and nutrition (mariecurie.org.uk) (Accessed:06/06/21)
National Institute for Health and Care Excellence (NICE) (2017) Available at: 1 Guidance | Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition | Guidance | NICE (Accessed:06/06/21)
