FEEDING AND HYDRATION FOR IMMINENTLY AND ACTIVELY DYING.pptx

A dying patient’s needs for food and water are far different from those of a healthy, active person. As the end of life nears, the body gradually loses its ability to digest and process foods and liquids. As organs and bodily functions shut down, minimal amounts of nutrition or hydration/liquids might be needed, if at all.

1. FEEDING AND HYDRATION FOR IMMINENTLY AND ACTIVELY DYING JAYA SHARMA RNRM, M.SC (N),PCC, Assistant Professor (Nursing) Atal Bihari Vajpayee Medical University, Lucknow, U.P , India

2. OUTLINE Feeding & Hydration. What are the factors considered when discussing feeding and hydration at the end of life? What are the goals in feeding and hydration for the imminently and actively dying? How to involve the caregiver in feeding and hydration for the patient.

3. Introduction The acts of feeding and providing fluids are closely tied to humankind’s basic beliefs regarding care (van de Vathorst, 2014). As patients become sicker and approach the end of life, physiological indications change, including routes and amounts of nutrition and hydration. As people approach the end of life, their appetite, desire for food and fluids, and ability to utilize them efficiently decrease (Danis, 2016).

4. FEEDING & HYDRATION Nutrition should be a priority early in palliative care. Food has a primary role in everyone’s life, including people with advanced illnesses. Chronic illnesses and their treatment exert a major impact on physical and psychological reserves, and at the end of life, problems

5. FEEDING & HYDRATION Clinically assisted hydration refers to the practice of providing fluids in the form of a drip, usually either intravenously or subcutaneously (a process known as hypodermoclysis) or via a nasogastric tube or gastrostomy to prevent dehydration. It does not include assisting a person to drink via the oral route.

6. F actors considered when discussing feeding and hydration at the end of life Marcolini EG, Putnam AT, Aydin A. History and Perspectives on Nutrition and Hydration at the End of Life. Yale J Biol Med. 2018 Jun 28;91(2):173-176. PMID: 29955221; PMCID: PMC6020733.

7. Family Beliefs Families may believe that hydration decreases pain, replenishes the body, enhances the effectiveness of medications, and in general can make the patient feel better both mentally and physically. At the end of life, families may feel responsible for maintaining their loved one’s dignity, and continued hydration may contribute to their perception that this is being accomplished. Strong beliefs in the value of nutrition and hydration at the end of life may give the family some satisfaction with helping the patient. Marcolini EG, Putnam AT, Aydin A. History and Perspectives on Nutrition and Hydration at the End of Life. Yale J Biol Med. 2018 Jun 28;91(2):173-176. PMID: 29955221; PMCID: PMC6020733.

8. Patient Beliefs Patients at the end of life lose interest in eating, have fatigue, altered body image, and a decreased ability to digest. These are all highly correlated with psychological distress. They may also believe that a gastrostomy or a nasogastric tube can make their quality of life worse. Marcolini EG, Putnam AT, Aydin A. History and Perspectives on Nutrition and Hydration at the End of Life. Yale J Biol Med. 2018 Jun 28;91(2):173-176. PMID: 29955221; PMCID: PMC6020733.

9. Cultural Beliefs Cultural differences exist regarding the meaning of continuing nutrition at the end of life. In Western cultures, eating is paramount to survival, and the lack of nutrition accelerates death. In contrast, the Taiwanese cultural belief is that a person should not die hungry, as his/her soul will be restless, thus the preference is to provide ANH. Marcolini EG, Putnam AT, Aydin A. History and Perspectives on Nutrition and Hydration at the End of Life. Yale J Biol Med. 2018 Jun 28;91(2):173-176. PMID: 29955221; PMCID: PMC6020733.

10. Provider Beliefs Health care providers have a significant influence on patients and families regarding decisions at the end of life. This influence comes in the form of education and their own beliefs in the setting of a trusted caregiver relationship Physicians who do not frequently participate in the care of terminally ill patients are more likely to recommend Artificial nutrition and Hydration and consider it necessary care. Marcolini EG, Putnam AT, Aydin A. History and Perspectives on Nutrition and Hydration at the End of Life. Yale J Biol Med. 2018 Jun 28;91(2):173-176. PMID: 29955221; PMCID: PMC6020733.

11. G oals in feeding and hydration for the imminently and actively dying National Clinical Guideline Centre (UK). Care of Dying Adults in the Last Days of Life. London: National Institute for Health and Care Excellence (NICE); 2015 Dec 16. PMID: 26741019.

12. G oals in feeding and hydration for the imminently and actively dying National Clinical Guideline Centre (UK). Care of Dying Adults in the Last Days of Life. London: National Institute for Health and Care Excellence (NICE); 2015 Dec 16. PMID: 26741019.

13. Comfort Feeding is KEY

14. For people being started on clinically assisted hydration Monitor at least every 12 hours for changes in the symptoms or signs of dehydration and for any evidence of benefit or harm. Continue with clinically assisted hydration if there are signs of clinical benefit. Reduce or stop clinically assisted hydration if there are signs of possible harm to the dying person, such as fluid overload, or if they no longer want it.

15. I nvolvement of caregiver in feeding and hydration for the patient https://www.mypcnow.org/fast-fact/counseling-adult-patients-and-caregivers-on-nutrition-during-the-dying-process/

16. Addressing practical concerns Assess what the family is concerned about. Many families desire their dying loved one to be encouraged to eat or drink because they fear physical discomfort or suffering from hunger or thirst. Clinicians should normalize the care and offer reassurance about symptom burden . Families should be encouraged to help the dying patient eat and drink what the patient is interested in and capable of comfortably taking. They should be taught how to provide oral care , as this can be a meaningful caregiving activity. https://www.mypcnow.org/fast-fact/counseling-adult-patients-and-caregivers-on-nutrition-during-the-dying-process/

17. Addressing emotion Given the cultural and emotional significance of food , these discussions can trigger strong emotions. Family members may feel helpless, guilty, or even complicit in the patient’s death if they cannot get their loved one to eat. Seemingly cognitive questions may be emotional responses. Acknowledging the underlying emotional distress can help families feel heard and supported https://www.mypcnow.org/fast-fact/counseling-adult-patients-and-caregivers-on-nutrition-during-the-dying-process/

18. Address religious or spiritual concerns Some patients and loved ones may cite religious or spiritual beliefs and concerns when making decisions about nutrition at the end of life. Exploring these and acknowledging their concerns are important first steps. Involving spiritual care providers such as a chaplain or community spiritual resources may be beneficial in these situations. https://www.mypcnow.org/fast-fact/counseling-adult-patients-and-caregivers-on-nutrition-during-the-dying-process/

19. The importance of language and phrasing  Family Concern Aren’t they suffering? Response “I can tell how much you care about them. We can provide a lot of comfort with good mouth care and sips or swabs of liquids. This is something you can help us with if you wish.” https://www.mypcnow.org/fast-fact/counseling-adult-patients-and-caregivers-on-nutrition-during-the-dying-process/

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