Guiding Family and Staff Through

The Journey of Nutrition Decline

Erin Blake, RD

Vanessa Young-Caimol, B.A., B.Ed., General Educator

Deer Lodge Centre

Dementia Care 2020

March 2, 2020

Objectives

• Identify resources to use when discussing nutrition decline

• Recognize the physiological changes at end of life

• How to start conversations about nutrition decline

Conversations around nutrition decline is like…

Definitions

• The declining process leading to death

End of Life

• The person receiving care in any settingClient

Physiological Changes with Aging

• Sensory changes

• Trouble chewing and swallowing

• Reduced digestion and absorption

• Constipation and diarrhea

• Medication side effects

Changes Related to Dementia

• Loss of memory as to when they ate last

• Easily distracted

• Lack of distinction between food and non-food items

• Decreased ability to feed ones self

Eating and drinking less is nature’s way

of leading to a peaceful and more comfortable death

Nutrition at End of Life

• Digestive system shuts down

• Food is NO longer necessary

• Decreased level of consciousness

• Decreased appetite and drinking less

Dehydration at End of Life

• Breathing is easier

• Less nausea, vomiting, and bloating

• Reduced urine output

• Decreased pain and discomfort

Discussion Barriers

• Emotions

• Education

• Culture

• Language

• Mode of communication

• Timing

Discussion Tips

• Family dynamics

• Use plain language

• Access interpreter services

• Timing

• Initiate conversation

• Cues- re-approach at another time?

• Empathize and summarize

Conversations in Long Term Care Information Sheets

• Nutrition challenges during early, middle, and late stages

Difficulties with meals for people with dementia

• Nutrition intake

• Pleasure feeds

Nutrition and swallowing at end of life

Conversations in Long Term Care Information Sheets

• Age related changesMeals in long term care

• Causes

• Signs

• Care planning

When a person has trouble eating and swallowing

• Non food related strategies for family

Nourishing the whole person

Scenario

Conversation between wife of a client who has dementia and home care nurse

Recommendations for improvement…

Scenario

Conversation between a social worker and the son of personal care home care client who is nearing end of life

Recommendations for improvement…

Implementation

• Where do conversations fit into current practice?

• What larger conversations or changes could support implementation in your area of work?

In Summary

• Eating and drinking less at end of life is natural and decreases discomfort

• Have frequent conversations with clients and families around nutrition decline

• Provide families with printed information to take away and review at a later time

Additional Resources

Contact your Clinical Dietitian or Coming soon-WRHA website- “Nutrition and Food Services” -“Client Education” -“Nutrition Decline Towards End of Life”

• Meals in Long Term Care Homes

• When a Person has Trouble Eating

• Difficulties with Meals for Person with Dementia

• Nourishing the Whole Person

• Eating at End of Life

• Healthcare Professional Resource (food intake and swallowing concerns)

Content contribution

• Jean Helps RD- Regional Nutrition Manager

• Tamara Wells- Clinical Nurse Specialist, WHRA

• Journey of Nutrition Decline Presentation developed by the LTC End of Life Working Group