Hospice Patients Alliance: Consumer Advocacy


DIETITIANS FOR OPTIMUM NUTRITION



Hospice dietitians assist the patient in achieving the best nutritional intake possible given the current state of his or her health. Dietitians have much experience in dealing with the obstacles to eating that often challenge the terminally ill. In conjunction with the physician, the dietitian may make suggestions about food types that are more appetizing to the patient or ways of preparing or serving the food that make it possible for the patient to eat.

Any patient who enters hospice must be evaluated at the time of admission to the hospice program, and if there is a dietary need, a dietitian should be provided to assist and educate the patient and family. Common problems such as nausea and vomiting are controlled with medications in some cases, while for others, a change of diet is sufficient. Hospice patients and families need to be aware of the changes occurring in the patient's body. Each disease process has different effects on the patient.

Many patients experience some alteration in their food intake during the course of their illness. It is common for the patient to reduce his or her intake as time passes and to choose different foods. With a terminal illness, there are changes which occur in the patient's metabolism, the way he or she processes food and the general activity of the body which maintains itself in good health. The normal process of taking in nutrients and building up the body's cells, tissues and organs is part of a normal metabolism.

With a terminal illness, there comes a time when the body is no longer creating new cells and building up the body. Cells and tissues begin to break down in what is called a "catabolic" state of metabolism. At this point, the body is no longer taking in nutrients, even if food is taken into the stomach by whatever means. If patients are forced to take in food at this time, the body may simply refuse to take it in and reject it, through vomiting or diarrhea. A dietitian or the RN casemanager will explain when this point is reached. However, withholding food before a patient reaches this state is not appropriate. The way to know the difference is to listen to the patient, determine if there is any appetite or ability to take the food in and retain it.

If you have any questions about your loved one's nutritional intake, ask the hospice RN casemanager for information, and if appropriate, she will arrange for the dietitian to visit and assess the patient's dietary needs.

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