Quality and support to the very end- Catering In End of Life Care

Changes in eating and drinking are common in people living with a terminal illness, and care caterers have an important role to play in providing individualised care.

“Loss of appetite is a normal part of the disease process but one path doesn’t fit all so it’s really important to provide individualised care,” explains Caroline Colquhoun-Lynn, primary healthcare dietitian at Manchester University NHS Foundation Trust. “Decision making about eating and drinking can be really complex. Sometimes it can be the last thing the patient has control over.

“Food is more than just nutrients. Eating is a feel good factor. Not eating can be linked to deterioration and death, whilst eating can equate to living and hope.” In the early phases of palliative care the individual is diagnosed with a terminal disease but death is not imminent. They may have years left to live and may be undergoing treatment to improve quality of life.”

Speaking at an NACC North Region seminar, Caroline told delegates that malnutrition is significant in palliative care. For example, 10-20% of deaths in patients with cancer can be attributed to malnutrition rater than the malignancy itself.

The consequences of malnutrition include impaired immune function, ability to cough leading to risk of infection, swallow, wound healing, muscle mass/strength and increased risk of falls. Caterers are advised to relax restrictions and allow patients to eat whatever they fancy.

“Menus should be adapted to include strong flavours,” says Caroline, “The nutritional content of food may no longer be of prime importance and the patient should be encouraged to eat and drink what they enjoy. Alcohol can also be a useful appetite stimulant.”

A spokesperson for Marie Curie Cancer Care advises: “It’s very common for someone to become less interested in food in the last few days of life. This is normal. Everyone with a terminal illness eventually stops eating and drinking.

“This doesn’t tend to be distressing for the person who is dying but it can be very difficult for their family and friends. Providing food for our loved ones is a big part of showing that we care for them. Family and friends often want to continue doing this and don’t want to feel that their loved one is hungry or thirsty.

“Family and friends often ask if the person can have artificial hydration and nutrition, for example tube feeding or subcutaneous fluids. For some conditions, this is an option. But for other conditions, and often when people are in their last days, there is no evidence that it helps people to live longer or improves their quality of life. “Explain to the family that eating and drinking less is normal in the last few days. This can be a difficult conversation. Ask for help from an experienced colleague if you don’t feel comfortable.”

For more information, visit https://www. mariecurie.org.uk/professionals/palliativecare-knowledge-zone/symptom-control/ hydration-nutrition.

David Barker, chair of NACC North, commented: “It is a privilege to care for people and provide love and support for them and their families at this difficult time, and I applaud the wonderful work carried out by catering staff in the nation’s hospices, hospitals and care homes.”