Nutrition and Hydration in Serious Illness

20 May Nutrition and Hydration in Serious Illness

Learn how palliative care addresses changes in nutrition and hydration during serious illness, focusing on patient comfort and quality of life rather than forced intake.

For individuals living with a serious or life-limiting illness, changes in appetite, weight loss, and decreased interest in food and drink are common. These changes can be distressing for both the patient and their loved ones, often bringing up concerns about nutrition and hydration. Palliative care offers a supportive and realistic approach to these challenges, focusing on comfort and quality of life rather than aggressive nutritional support.

Understanding the natural changes that can occur and how the palliative care team can help navigate them is an important part of the journey.

Natural Changes in Appetite and Metabolism:

As a serious illness progresses, the body’s metabolism changes. There is often a natural decrease in appetite and the body’s ability to process food and fluids. This is a normal part of the disease process and not necessarily a cause for alarm or a sign that the person is “giving up.”

The Palliative Care Approach:

The palliative care team’s approach to nutrition and hydration is centered on the patient’s comfort and their goals of care.

• Prioritising Comfort: The primary goal is to ensure the patient is comfortable and that any discomfort related to eating or drinking is minimised.
• Honouring Patient Preferences: The team respects the patient’s wishes and preferences regarding food and fluids. If a patient has little appetite or finds eating difficult, they are not forced to eat or drink.
• Managing Symptoms Affecting Intake: The team works to manage symptoms that can interfere with eating and drinking, such as nausea, vomiting, mouth dryness, pain, or difficulty swallowing. This might involve adjusting medications or suggesting strategies to make eating more comfortable, such as smaller, more frequent meals or softer foods.
• Oral Care: Good oral hygiene is essential for comfort, even if a patient is not eating or drinking much. The team can guide on keeping the mouth clean and moist.
• Offering Favourite Foods: When a patient does have an appetite, the focus is on offering foods they enjoy, regardless of nutritional value. The pleasure of taste and the social aspect of sharing a meal become more important than meeting specific dietary guidelines.
• Addressing Family Concerns: It can be emotionally difficult for families to see a loved one eat and drink less. The palliative care team provides support and education to families, helping them understand the natural progression of the illness and how to best support their loved one without causing distress related to food intake.
• Discussing Artificial Nutrition and Hydration: The palliative care team can have open and honest conversations with the patient and family about the potential benefits and burdens of artificial nutrition (like feeding tubes) and hydration (like IV fluids) in the context of their goals of care. In many cases of advanced illness, the burdens of these interventions outweigh the benefits and do not necessarily prolong life or improve comfort.

Focusing on Quality of Life:

Instead of focusing on forcing nutritional intake, the palliative care approach emphasises the quality of the patient’s remaining time. This means:

• Enjoying small amounts of favourite foods if desired.
• Maintaining comfort and reducing symptoms related to eating or not eating.
• Preserving dignity and respecting the patient’s autonomy.
• Finding comfort in other ways, such as through good oral care and moistening the mouth.

Changes in nutrition and hydration are a natural part of serious illness progression. The palliative care approach is about navigating these changes with compassion and focusing on the patient’s comfort and well-being above all else. Reach out to us at https://angelwingshospice.org/contact-us/