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Part II Nutrition Assessment, Consequences, and Implications

BOX 19.3 Views of Death and Dying Older People

● Spend more time thinking about death ● Have rehearsed death

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Have a lifetime of coping mechanisms upon which to call

● Often state that they are not afraid to die ●

● ●

View death more calmly and peacefully than the young

Tend to espouse more traditional religious feelings and beliefs

Think about the last opportunity to see loved ones, bringing business affairs to completion, and reminiscing about life

● Are less concerned about cessation of experiences ●

Value the quality of the remaining time more than its quantity, often forgoing therapy in the last few months of life that may make them uncomfortable

● Fear the process of dying more than the end result

Source: Bohnet NL. The dying elderly. In: O’Rawe AM, Bohnet NL, eds. Nursing Care of the Terminally Ill. Boston, MA: Little, Brown & Co; 1986:227-233.

are not eating well and are losing weight, they may wish to discuss aggressive nutrition interventions with health care professionals. Health care team members need to demonstrate awareness that clients may be afraid to verbalize their wish to discuss tube feeding or parenteral feeding by offering in advance to discuss these issues should they become important to the client and family at any time.

When cancer therapy is completed, the emotions of the client and family may range from severe depres- sion to unbridled (but cautious) joy, depending on the outcome of treatment. Relief will be felt by all to some extent (10). When therapy is complete, nutrition geared toward getting the client’s physical strength back is important. Weight goals need to be set, possibly with a margin of safety for future therapy. The merits of diet in secondary prevention need to be considered if the client and family desire, but the merits need to be tem- pered to avoid imposing guilt or overpromising a cure or prevention of recurrence (8).

Clients and their families often go through a period of fear of abandonment when cancer treatment has ceased. Cessation of treatment should not mean cessation of care (25). Most clients and families appreciate being told options in straightforward but empathetic terms. Counseling for the dying client should address issues such as (26):

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how the disease and dying processes affect the desire for food;

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how changes in appetite and ability to eat cause changes in food intake, bodily appearance, and bodily function;

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specific dietary measures for symptom control;

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relief measures that will be available as the cli- ent’s condition deteriorates;

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the availability of community nutrition and food resources; and

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how to reach the nurse and RDN when questions arise and assistance is needed.

Reevaluating Goals and Intervention Self-evaluation, evaluation of the established plan of care, and evaluation of the ability of the client and family to achieve desired goals are standard procedure during and after visits from members of the health care team. It is only with such evaluation that progress can be noted and the care plan can be modified as neces- sary. When goals are not achieved, blame should not be imposed on clients, families, or health care team members. Two dietary situations that nurses and RDNs frequently encounter are (1) the client who cannot and will not eat and (2) the client who can and wants to eat

Younger People

● Have limited thoughts or experiences with death ●

Many middle-aged people state that they are afraid to die.

● ● ● ● ● ●

The very young often indicate no or little fear of death.

Often cannot identify what beliefs they hold sacred

Tend to deal primarily with the experiences of the present

Cessation of experiences is a great sorrow to most young people.

Often endure almost intolerable therapy and side effects to buy a few more days of life

Fear the state of death more than the process of dying