Nutrition in palliative care

The aim of palliative care is to maintain the patient’s functional capacity and a good quality of life for as long as possible. This includes maintaining the patient’s nutritional status or delaying its decline, and minimising weight loss.

When planning and providing nutrition care, the focus is on listening to the patient’s individual wishes and taking them into account. It’s also important to involve the patient’s loved ones in nutritional planning, since they are often in charge of matters related to nutrition.

The goal is to support the patient’s ability to eat normally for as long as possible, because it’s the most natural and enjoyable way to obtain nutrition. In case eating is not possible due to illness or treatments, the patient is provided with an individualised nutrition care plan.

Texture and consistency of food

As the illness progresses, eating may become more difficult due to challenges such as swallowing problems. This requires dietary changes in order to make eating easier for the patient. These changes may include changing the texture and consistency of food to be easier to swallow and digest. To make swallowing easier, food can be mashed with a fork, cut into bite-sized pieces, or blended.

Food enrichment

As appetite decreases, portion sizes do too; in that case, food can be enriched by cooking with or adding cooking oil, cream, butter, or other ingredients that increase the energy that the food provides while also making it as tasty as possible. Sweet snacks may also be more appetising. Sometimes cold foods are more palatable than hot meals. If the patient’s sense of taste is impaired, they might prefer pickled foods or berries.

Frequent small portions, according to preferences, in good company

Eating can be supported by offering smaller portions several times a day. Good choices for meals include ones that are easy to digest and correspond with the patient’s preferences. In addition, there are various nutritional supplements available in pharmacies and supermarkets to support nutrition, if the patient finds them appetising.

It’s also worth remembering that mealtimes are social events – eating in good company often makes the food more appetising than it would be when eaten alone.

Eating may be hindered by problems caused by illnesses or medications used to treat them. These problems may include nausea, constipation, or dryness of mouth. The aim should be to treat any problems preventing the patient from eating as effectively as possible.

Nausea

If medication is used to treat or prevent nausea, it’s important to take the medication as instructed. For example, medication preventing or reducing nausea is often taken about 30 minutes before mealtimes, allowing the medication to take effect before the intended mealtime.

Constipation

Another problem that may decrease appetite is constipation. Constipation can be caused by many medications, such as strong morphine-like drugs. Other causes of decreased bowel motility include reduced intake of food, insufficient intake of fluids, and lack of physical activity.

The patient may experience constipation even despite only eating small amounts of food. This is because the secretions of the gastrointestinal tract and the waste formed in the bowels produce stools regardless. This is why it’s important to pay attention to bowel movements regardless of the circumstances.

Constipation may be prevented and treated with medications such as stool softeners or laxatives stimulating the bowels. A diet high in fibre (for example wholegrain products, fruits, vegetables) as well as physical activity according to the patient’s energy levels may also help relieve constipation.

Dry mouth

Dryness of mouth leads to decreased sense of taste, which in turn decreases appetite. Measures to ease dryness of mouth include moistening the mouth frequently using a small amount of fluid, ice cubes, or oil, chewing pastilles or chewing gum, or with dry-mouth products available in pharmacies.

An advanced illness often leads to decreased appetite and hunger. Even small portions make the patient feel full fast. There may also be changes in the patient’s sense of taste, and foods that used to taste good are suddenly unappetising.

As the illness progresses, the absorption of food – to be used as building blocks for the body through the metabolic system – is reduced. As a result, even if the patient is eating or receiving nutritional support, the body is no longer able to make use of the nutrients it receives.

In the case of a dying patient, nutrition care no longer improves the patient’s prognosis or wellbeing, but may instead result in nausea and discomfort for the patient. Here, small snack-sized portions of the patient’s preferred foods to eat are often enough.

During the last days of life, as consciousness fades and the ability to swallow decreases, moistening the mouth should be prioritised over food.