HOME-BASED NUTRITION CARE/ PALLIATIVE CARE AND END-OF-LIFE INTERVENTION STRATEGIES.
It is important to distinguish between the nutrition support offered to patients during the different stages of a disease condition. Corresponding support may include:
Home-based nutritional support is for patients post hospital discharge or patients with disease condition affecting the ability to continue with a normal and optimal oral diet.
The following patients or disease conditions that often need the support of a dietician as part of home-based medical care includes:
- Cancer patients (undergoing chemo/ radiation to optimize weight and strength for next sessions)
- Weakness and inability to continue with normal life post ICU (temporarily or permanently)
- Disabilities (Prader Willi; Downs syndrome; cerebral palsy)
- HIV (early stages)
- Premature infants
Home-based care is where optimal nutrition should be offered to the patient, it may or may not include invasive measures e.g. the insertion of a nasogastric- or percutaneous- or jejunostomy feeding tube (PEG/ JEJ) to ensure optimal nutritional status and a speedy recovery or to prevent complications e.g. aspiration pneumonia, weight loss and nutritional deficiencies.
PEG/ JEJ Feeds is a feeding tube which passes through the abdominal wall into the stomach/ intestines so that feed, water and medication can be administered without swallowing. These are used for people who have swallowing problems or who are unable to take enough food and fluid orally to meet their nutritional requirements.
It is essential that a dietician calculate the requirements of these patients in order to optimize the quality of their diet as quantity is often drastically reduced in these patients. Beat Dieticians could assist with home-based follow ups, weight monitoring, dietary advice on enrichment and food consistency adjustments. We further support common complications in these types of patients e.g. poor appetite, nausea and vomiting, diarrhea and constipation.
Beat Dieticians could also assist with medical aid motivations to provide the patients with the best possible products on the market for their specific disease condition.
This type of care is when a patient has been diagnosed with a disease that can not be cured, but where quality of life is still optimized. It might include pain management and medication to delay the progression of the disease.
Often invasive procedures to ensure optimal feeding will not be considered during these stages. Feeding tube insertions might be avoided unless it is the wish of the family or patient to proceed with such measures.
Beat dieticians would provide oral supplements and advice on dietary modifications in these patients.
Disease conditions that might need palliative nutrition care includes:
- End stage cancers
- End stage AID
- End stage Dementia
These are the very last days of a patient’s life. Medical intervention to stop the progression of the disease has been withdrawn. Pain management might still be included. The responsibility of a dietician during this phase is really to put the mind at ease of the family members and to explain the physiology of feeding during these very last days of life.
No extreme measures should be implemented. The patient should drink or eat what ever they feel like or can manage. No force feeding or aggressive supplementation is recommended during these stages.