NUTRITIONAL INFORMATION FOR HOSPICE FAMILIES

General Information: Nutrition is an important part of our lives from the time we take our first breath as an infant.  We place great importance on meal planning and social interaction during meal times.  Often feeding and preparing meals for a loved one is a way of communicating love, concern and caring in a direct and nonverbal way.

Whenever one is ill, his/her appetite decreases whether the illness is the flu, an injured ankle or a terminal illness. The body’s needs for high calorie and protein foods are less because of decreased activity, lack of exercise and increased bed rest.  Nutritious foods are important for adequate healing.

Hospice patients often experience decreased appetite, nausea, vomiting, pain and constipation.  The most common problems many families face are finding the right kinds of foods and difficulty in getting the patient to eat.  Too often this “food struggle” may cause tension between the patient and the family.  This struggle may be avoided by letting the patient decide what and when to eat.  When faced with a terminal illness, a person adjusts priorities.  The patient may want to spend time and energy on relationships rather than on food. The body is much wiser than we give it credit for and will give us messages about what we need to sustain life.  The patient is facing the end of life and the sustaining value of food is often not important. Many times the disease process affects taste buds and makes foods taste bland, salty or sour.

FOOD SUGGESTIONS AND HELPFUL HINTS:

1. Offer small, frequent meals throughout the day rather than maintaining a three-meals-a- day routine.  Three to five meals a day of light foods are tolerated more easily.

2. Serve small portions on the plate so the patient does not feel overwhelmed or a sense of failure because he/she cannot clean his plate.

3. Alter the times of meals. Offer food when the patient is pain-free and has the most energy; i.e., morning, mid-afternoons, and after pain medications.

4. Don’t force food at any time. This can develop into a struggle in which family may feel rejected and the patient feels ungrateful or guilty.

5. Liquid meals are often best when the patient is nauseated or in pain; for example, soups, shakes, yogurt, ice cream, cool drinks, etc.

6. Ice chips, flavored and unflavored, relieve the feeling of dryness and discomfort when the patient no longer wants to eat or during

7. A heating dish for baby foods helps keep small amounts warm without much kitchen preparation.

8. Baby foods sometimes satisfy the need for soft, bland foods which can be made appetizing with spices and seasonings.  Spoon baby food onto a plate or saucer rather than feeding the patient directly from the jar.

9. An infant’s cup with a lid on the top allows the sick person to drink unassisted without worry or spillage.

10. Liquid food supplements brought over-the-counter are often tolerated well.

11. Instant breakfast mixes can easily serve as meal.

12. When a person is nauseated, cooler foods are often tolerated better.

13. To aid digestion, elevate the head of the bed or place pillows behind the patient’s back. Encourage the patient to sit up for 20-30 minutes after meals, if they are able to.

This information may be helpful to you in caring for your family member.  Your doctor may recommend a specific diet which should be followed if possible.  Feel free to discuss this information with your Hospice nurse for further explanation.  The Hospice staff is always looking for new ideas to assist you.  If you have any questions or suggestions not covered in the above information, please let us know.

NUTRITIONAL MANAGEMENT

I. Anorexia –Loss of appetite

1. Encourage

1)      Small, frequent, highly nutritious meals.

2)      Create a pleasant, relaxed dining atmosphere with an         attractive table setting, quiet music and good company.

3)      Light exercise, such as walking, before a meal.

4)      Use high-protein, high calorie supplements.

5)      Rely on old favorite foods and experiments.

6)      Keep snacks available.

B.  Discourage

1)      Large servings.

2)      Forcing patient to eat.

II. Dysgeusia - - Loss or change of taste

A.     Encourage

1)      Use meat substitutes such as eggs, cheese, dried beans, and peanut butter.

2)      Use extra seasoning and spices.

3)      Acid foods (if tolerated) stimulate taste buds.

4)      Appeal to the sense of smell and sight when preparing  foods.

5)      Try protein foods cold or at room temperature.

6)      Marinate meats in fruit juice or sweet wines.

7)      Experiment with texture, temperature, and seasoning  variations –try new foods.

8)      Sugar tones down salty and acid foods.

9)      Salt tones down sugar and acid foods.

10)    Drink liquids or suck candies to eliminate bad taste.

III. Sore mouth or throat

A.     Encourage

1)      Use plenty of liquids, sauces, gravies, butter.

2)      Choose soft or blenderized foods.

3)      Small, frequent, highly nutritious meals.

4)      Bland foods.

5)      Serve foods at room temperature.

6)      Supplementary feedings, such as eggnog or milkshake.

7)      Use a straw when mucositis is present.

8)      If sore mouth is a new problem, ask the nurse to check for “thrush”

B.     Discourage

1)      Rough, coarse, dry or fried foods.

2)      Acid and spicy foods.

3)      Alcohol, carbonated beverages.

4)      Extremely hot or cold foods.

IV. Dry mouth

A.     Encourage

1)      Dunk or soak food in liquids.

2)      Rinse mouth frequently.

3)      Suck candy or chew gum.

4)      Eat food lukewarm or cold.

5)      Artificial saliva substitute can be used.  These over-the-counter aids are available at any drug store.

B.     Discourage

1)      Alcohol

2)      Smoking

V. Nausea and vomiting

A.     Encourage

1)      Carbonated beverages, such as Coke or Sprite

2)      Small, frequent meals.

3)      A light meal.

4)      Eat and drink slowly, relaxation

5)      Dry crackers or toast after periods of rest or sleep

6)      Cold, non-aromatic foods such as cottage cheese and fruit, cold meat plates or sandwiches.

7)      Cold, clear liquids, such as grape juice, jello, popsicles, Gatorade (between meals).

8)      Salty foods, such as broth.

9)      Tart foods, such as lemons and dill pickles

10)  Try fresh air and loose clothing.

B.     Discourage

1)      Alcohol

2)      Fried, greasy foods or those with high fat content.

3)      Cooked foods with strong odors.

4)      Going for long periods without eating

5)      Overly sweet foods

VI. Diarrhea and Loose Stools

A.     Encourage

1)      Small, frequent meals low in residue or roughage.

2)      Eat food warm instead of hot.

3)      High-protein diet.

4)      Drink plenty of liquids between meals.

5)      Eat foods rich in potassium (i.e., banana, orange juice).

6)      Low residue or elemental supplement to increase calories and protein.

B.     Discourage

1)      Alcohol

2)      High fiber foods, such as fruits, beans, etc.

3)      Spicy or highly seasoned foods.

4)      Fried foods, greasy foods, or those with a high fat content.

5)      Gas-forming foods (i.e. dry beans, cabbage)

6)      Milk and milk products, unless well-tolerate.