CHAPTER

Health care professionals are challenged to provide the highest quality of care and quality of life possible for clients and their families, regardless of health care setting. This becomes especially important for those who are terminally ill and may be receiving palliative care, which aims to improve the quality of life of patients and their families through the prevention and relief of suffering. Clients, family members, hospice nurses and other hospice team members, facility administrators, surveyors, risk managers, corporate legal departments, and plaintiff attorneys are all con- cerned about nutrition care (1). Additionally, all members of the health care team have the responsi- bility to address the moral, ethical, legal, and risk-management issues associated with nutrition care (2).

THE MEANING AND VALUE OF

FOOD AND DRINK Food and drink are among life’s greatest pleasures, and the meaning of food and drink often changes during illness and end of life. When individuals are healthy and their appetite is good, food and drink are generally enjoyed and often taken for granted, regardless of age. When individuals are ill and their appetite is poor, food and drink can be a source of conflict and take on greater importance. This is par- ticularly true for older adults, especially when diag- nosed with a terminal illness (3).

It is important for health care providers to understand the psychological aspects of a diagnosis of terminal illness such as Alzheimer’s disease, dementia, cancer, and end-stage liver, kidney, or heart disease. Such diagnoses elicit powerful emo- tions, including fear and grief, and can have a shat- tering effect on a client’s self-image, particularly one who has had a disfiguring surgery (4). The emotions that burden clients often manifest themselves in changes in eating. Sometimes such

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Palliative Care: End of Life

emotions can cause overeating, but more often these emotions dampen the appetite (4). Clients diag- nosed with a terminal disease commonly feel a loss of control of life’s events and anxiety over the per- ceived incompleteness of their lives. Many clients experience guilt associated with their past or present lifestyle, and many focus on failed or strained relationships and failure to accomplish goals. They also may have fears of abandonment, pain, the dying process, physical and mental dis- ability, or dependence on others (5). Some may feel lonely and abandoned by family members who cannot or do not visit as often as the client feels they should. This may be especially true for those clients and families who primarily believe in tight- knit relationships and always taking care of each other in the home.

The dying process itself can diminish appetite and alter nutritional needs in ways such as (6):

The anatomical, physiological, and metabolic changes that occur because of various diseases can decrease gastrointestinal (GI) absorption and increase nutrient requirements, such as frequently occurs in clients with AIDS, who often develop severe diarrhea and malabsorption.

The dying process slows many body functions, including gastric emptying, which results in increased satiety, decreased hunger, and fre- quent food intolerances.

Medical interventions, such as chemotherapy, alter metabolic processes and frequently result in increased nutrient requirements. Even pallia- tive medications, such as narcotics, impact nutrient needs when side effects, such as nausea, vomiting, and constipation, occur.