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Palliative Care Platform

Palliative Care Platform

Caring Tips >Food and Nutrition

Dietary Goals for Palliative Care

At early stage of palliative care

The most basic goal of palliative care is to help patients maintain physical comfort, improve their quality of life and minimize the symptoms. Therefore, patients will be recommended to consume more nutritious foods and drinks on days when they feel good. Even if they continue to experience weight loss, dietary adjustments can still help patients increase their physical strength and make them feel more energetic.

At later stage of palliative care

The goal of palliative care is to ensure the comfort of patients. Do not urge the patients to eat if they are unwell or not enjoying eating as this may make them feel stressed or even more uncomfortable. Also, forcing them to eat will not help improve or reverse their conditions.

When changes in physical conditions

The physical conditions and nutritional needs of patients undergoing palliative care will change with the disease progression, such as:

  • After a long-term reduction of food intake, patients may experience slowed metabolism and require less nutrition
  • Patients who rest in bed for a long time or have a reduced activity level will require less nutrition and have a smaller appetite
  • Patients may have weakened gastrointestinal digestion, including slowed capacity of gastric emptying, which causes them to feel full easily or feel hungry less often
  • Studies found that many palliative care patients do not feel hungry and thirsty

Some patients may have symptoms that affect eating, such as pain, nausea, vomiting, dyspnoea, loss of appetite, insomnia, constipation, diarrhoea, oedema, dry mouth, abdominal distension, ascites, itchy skin, dysphagia, and confusion. Since diet and symptom management are closely related, the key is to manage the symptoms properly:

  • After the pain and other symptoms are under control, many patients can maintain their diet until the last days of their lives
  • In case of pain, take pain medications as instructed by doctors
  • In case of nausea or vomiting, take anti-vomiting medications as instructed by doctors

If the symptoms persist, consult the medical team as soon as possible.

Closer Look at Eating and Drinking

Sometimes, diet may cause different problems for patients, such as:

  • Causing fear or pain…” It’s suffocating to eat solid food, I can’t breathe.”
  • Causing guilt…” You’ve made so much effort to cook the food. I know I should eat it, but I really can’t…”
  • Patients may also want to decide on or control their own diet

Sometimes, the patient’s ability to eat may be a sign of “not giving up” for the family, who will hold on to the hope that “as long as he/she eats, he/she will stay alive”, or carers may see their ability to prepare foods the patient loves as an important expression of care to patients.

When the patient stops eating, the family may often feel hopeless as the refusal to eat can be seen as despair, abandonment and rejection of love. Family or carers may also urge the patient to eat worrying that the patient may suffer from malnutrition, which causes stress or even conflicts on both sides. Studies have shown that family or carers admitted having nagged, forced or begged patients to eat while 70% of the patients expressed their wishes to take control over the matter rather than have their family or carers focusing on it.

Sometimes, patients need not eat so much, and a small amount of food can already make them feel comfortable, as they may not feel hungry at all. Their refusal to eat may be a sign of their acceptance of a natural death.

Cachexia

When the disease progresses to a certain stage, some patients will lose weight and become extremely thin, which is commonly known as cachexia. This is a complex syndrome of metabolic abnormality. Its triggers include insufficient calorie intake, increased energy consumption, metabolic changes and the effect of cytokine. Patients may experience symptoms or signs such as loss of appetite, weight loss, muscle atrophy, decreased activity level, fatigue, anorexia, satiety and emaciation.

Studies have shown that early nutritional intervention can slow down the development of cachexia and help improve the nutritional status and physical functions of patients. It has also been pointed out that intake of omega-3 fatty acids can slow down muscle loss. The recommended serving size is 1.5 g to 2.0 g of omega-3 fatty acid per day, which is roughly four to six taels (150 to 200 g) of fishes such as sardines, salmon or tuna. In addition, patients can also drink nutritional formula or take fish oil pills. However, beware of the amount of omega-3 fatty in the product and consult a dietitian in case of any questions.

So far, there is yet no effective preventive method and treatment for cachexia.

General Dietary Advice

When patients feel great, they are encouraged to eat more to improve their mental and physical state. Here are some suggestions:

  • Choose their favourite foods
  • Prepare some ready-to-eat foods at home
  • Maintain the habit of having small frequent meals
  • Let the patients eat more when they are in a good mood, good spirits or have good appetite
  • Try preparing appetizing foods, such as sour ginger, dried fruits and processed vegetables, lemon water, vinegar and lemon tea
  • Serve small portions of food at a time, such as in small bowls and cups
  • Family members can keep patients company during eating
  • Relax and eat slowly in a comfortable environment
  • Sit comfortably when eating, such as having a soft pillow to support the back
  • Provide a comfortable and well-lit environment
  • Clean their mouth after eating and let the patients rest
  • If necessary, change the consistency of the food, such as shredding or boiling the ingredients to facilitate eating
  • If the patient is too tired, use a straw to take food in liquid form slowly
  • If the patient has poor appetite, check whether there are too many dietary restrictions and relax some depending on the situation

Foods high in protein and calories

When the patients have poor appetite, try to give them a small portion of foods high in protein and calories for multiple times, such as:

  • Congee (with minced meat, fish filet, egg drop)
  • Dumplings, wontons, fish balls, boiled eggs
  • Fried eggs, baked beans
  • Barbecued pork buns, vegetable meat buns, steamed buns, custard buns
  • Rice rolls, dim sum, turnip cake, taro cake
  • Sandwiches (eggs, ham, tuna, sardines, cheese), French toast, toast (butter, peanut butter, salad dressings, jam, sweetened condensed milk)
  • Soup residue (potatoes, yam, carrots)
  • Digestive biscuits, sandwich cookies, cookies, wafers
  • Cakes, egg rolls, egg tarts, western cakes
  • Red bean cake, coconut milk cake, white sugar cake, steamed rice cake, red bean pudding, split pea and coconut cream pudding
  • Tofu pudding, stewed egg, yoghurt, ice cream, pudding, jelly
  • Sweet soup (sweet walnut soup, sweet black sesame soup, sweet peanut soup, pumpkin soup, almond milk, sago in coconut milk, red/green bean soup, yuba egg sweet soup, sweet potato sweet soup)

If the patients get too tired to eat solid foods, use a straw to have food in liquid form, such as

  • Nutritional supplements, fresh milk, soy milk, milkshakes, Ovaltine, Horlicks, Milo, chocolate milk, instant oats, instant three-in-one beverages
  • Yuba egg sweet soup, fish soup, stew, cream soup
  • Honey water, watercress honey drink, grapefruit honey drink

Change the consistency of foods

Patients of palliative care tend to find foods with softer textures or fluid easier to eat, or they may have difficulty swallowing or chewing. It is recommended that carers try to prepare foods in different consistencies, such as:

Grains
  • Plain congee, congee (with meat, fish or egg), oats in nutritious milk, porridge for babies
  • Soft rice, thick congee, alphabet pasta, rice flat noodles, macaroni, rice vermicelli, rice rolls
  • Cooked potatoes (with skin peeled), carrots, yam, sweet potatoes, pumpkin, bulbus lilii
Meat, fish, egg and soy products
  • Meat stew, minced meat, fish, meat stew for babies, yuba, steamed fish, fish fillet, finely chopped meat, steamed egg, stewed egg, steamed tofu, egg tofu
  • Use a blender to mince cooked meat into a paste
Melons and vegetables
  • Finely chopped wax gourd, winter melon, pumpkin; boiled tender leaf vegetables, vegetable soups
  • Use a blender to make a paste out of cooked melons and vegetables

Fruits

  • Soft fruits, such as: mango, kiwi, dragon fruit, melon, water melon, papaya, ripe banana, ripe pears
  • Apple puree, canned fruits, fruit puree for babies
  • Use a blender to make a fruit puree or juice

Nutritional supplements

Nutritional supplements can provide energy to patients with difficult eating or poor appetite; they can also serve as meal substitutes.

Balanced nutritional formulas can be divided into general, disease and high-calorie formulas. They are made in different flavours for patients to choose from based on their personal preferences. You can consult a dietitian for the choice of nutritional formula and their drinking methods.

To make nutritional supplements more delicious, it is recommended to try different drinking methods, such as:

  • Adding Horlicks, Ovaltine, Milo, almond milk, coffee, tea or oats to nutritious milk
  • Adding fresh milk or soy milk to nutritious milk to reduce the sweetness
  • Using nutritious milk to make stewed eggs or milk
  • Mixing it with fruits or papaya, condensed milk or cream to make a milkshake
  • Using the nutritious fruit juice to make jelly
  • Using the nutritious broth to make congee or porridge
  • Adding the nutritious broth to cream soup to make cream soup with meat or mixing egg drops with the nutritious broth to make meat soup with egg drops

Alternative Treatments, Adjuvant Therapies and Folk Prescriptions

Alternative treatments, adjuvant therapies and folk prescriptions have their own benefits and risks. Family members and patients should make careful considerations before deciding for or against them. Here are some factors to consider:

Benefits

  • Reduce the symptoms and side effects patients experience to improve their quality of life
  • Encourage patients to take a more active part and increase their say in their condition, thereby improving their quality of life
  • Being able to provide support for the patients will make their family feel satisfied and without regrets
  • It is generally believed that diet therapies make use of natural ingredients, which are safer and healthier than prescription drugs and have fewer side effects

Risks

  • Some diet therapies may affect the efficacy of certain drugs
  • Some patients will lose their appetite even more due to excessive diet restrictions
  • Some diet therapies will increase the discomfort of patients
  • Some patients and their family may have different opinions on diet or alternative treatments, which may create stress, disputes or even conflicts
  • Some alternative treatments claim to be able to cure all diseases or even claim to have the power to bring the dead back to life, misleading the patients or their families, or giving them false hopes. As time goes by and the expected results have not been achieved, patients and their family may feel extremely disappointed or even depressed
  • Some alternative treatments are very expensive and bring heavy financial burdens to the families of patients, who may become indebted as a result.

Consult healthcare professionals in case of any questions about alternative treatments, adjuvant therapies or folk prescriptions.

Side Effects or Symptoms: Dietary Recommendations

Side effects or symptoms
Dietary recommendations
Side effects or symptoms:
Poor appetite/ loss of appetite
Dietary recommendations:
  • Eat your favourite foods and temporarily relax some dietary restrictions or abstinence
  • Eat a feast when you have good appetite or spirits
  • Eat small frequent meals six to eight times a day
  • Use nutritional supplements as a meal substitute
  • Serve food in small portions, such as in small dishes, to facilitate eating
  • When you have poor appetite, add soup to your meal and take the soup and its ingredients, including
    • Soups high in carbohydrates, such as potatoes, radish, pumpkin, beans and yam
    • Soups high in protein, such as meat, fish, tofu, yuba, beef shank, egg drops
    • Concentrated foods, such as adding egg, tofu, beans, minced meat in congee or soup; adding formula milk, evaporated milk, nutritious milk or egg to oatmeal
  • Choose foods with a smooth texture to facilitate eating, such as noodles in soup, wonton, steamed egg and steamed tofu
  • Avoid excessive consumption of beverages low in calories, such as vegetable juice, fruit juice, clear soups without residue or clear tea
Side effects or symptoms:
Bloating or getting full easily
Dietary recommendations:
  • Chew slowly, eat a small amount per meal and maintain the habit of small frequent meals
  • Consume liquids only one hour before or after eating
Side effects or symptoms:
Change in the sense of taste
Dietary recommendations:
  • If you find the food too plain, add some vinegar, salt, Worcestershire sauce, ginger, cooking wine, cheese, celery, onion, garlic, herbs, pickles or spices to enhance the flavour
  • Eat your favourite foods more often or stop eating foods that upset your appetite
  • If the taste of the food discourages your appetite, try some cold dishes, such as smoked pork knuckles and drunk chicken
  • Change cooking methods frequently and pay attention to the combination of colour, aroma and taste to stimulate appetite
  • Brush your teeth and use mouthwash more often to keep your mouth clean, which may help restore your sense of taste
Side effects or symptoms:
Nausea
Dietary recommendations:
  • Eat small frequent meals; chew slowly; the nausea will get more serious if the patient does not eat anything (empty stomach)
  • Prepare foods at room temperature; hot foods or foods with strong flavour will intensify nausea
  • Try preparing
    • Dry carbohydrates, such as soda crackers, savoury biscuits, bread and toast
    • Sour or savoury foods, such as sour ginger and potato crisps
    • Carbonated drinks may help (but patients with bloating should avoid it)
  • Keep the cooking light and avoid foods with strong taste
  • Keep good air circulation indoors
  • If possible, let others cook and try to rest after eating
  • Avoid fatty or fried food
  • Try to avoid strong food odours and cooking fumes
  • Take anti-nausea medications as instructed by doctors
Side effects or symptoms:
Vomiting
Dietary recommendations:
  • Remember to take anti-vomiting medications as instructed by doctors
  • Start eating only after vomiting has stopped:
    • Start with a small amount of clear beverage, such as water, apple juice and clear soup
    • Gradually try thicker beverages, such as milk, cream soup and congee
    • After that, try solid foods that are easy to digest, such as noodles in soup, bread and oats
  • Have small frequent meals
  • If you continue to vomit or the symptom is severe, consult the doctor immediately
Side effects or symptoms:
Dry mouth
Dietary recommendations:
  • Bring a drink with you and take a few sips to keep your mouth moist
  • Try ice cubes or popsicles
  • Chew sugar-free gum, hard candy or drink lemon water to stimulate saliva secretion
  • Use sauce or gravy to moisten food
  • Take a small amount of soup and drinks together with food to help swallowing
  • Eat soft and smooth foods, such as tofu, steamed egg, noodles in soup, congee and wonton
  • Try foods and drinks (to make a juice out of it or boil it in water) that clear your inner heat and nourish yin to enhance moisture, such as pears, sugar cane, watermelon, water chestnuts, carrots, strawberries, monk fruit, smoked plum, citrus, honey and soy milk
  • Rinse your mouth frequently to keep it moist
Side effects or symptoms:
Fatigue
Dietary recommendations:
  • Even if you are not hungry, keep eating small, frequent meals or drink nutritional supplements
  • Eat more when you have energy and appetite
  • Stay hydrated to prevent dehydration, as it will make you feel even more drained
  • Prepare some instant foods or order takeaways at any time
  • Always prepare some snacks that you can eat at home or anytime
  • Prepare a large portion of food beforehand and eat it throughout the day, or store it in small portions in the fridge, so that you can easily heat it up at any time; ask your family or friends to help with cooking
Side effects or symptoms:
Constipation
Dietary recommendations:
  • Constipation can be caused by many factors, such as insufficient fibre intake, insufficient consumption of liquids, lack of exercise, eating too little or side effects of pain medications. Patients are recommended to:
    • Eat foods high in fibre, such as fruits, melons and vegetables, oatmeal, sweet potato congee and sweet sesame soup
    • Try foods that contain “natural laxatives”, such as prunes, prune juice, figs, honey, papaya, apples, apple juice and pears
    • Try to have plenty of liquid; you can have prune juice
    • If your physical condition allows, do some light exercise, such as walking, to help intestinal peristalsis
  • If constipation does not improve after diet adjustments, consult your doctor about medications that help with bowel movement to relieve the symptoms

Spending the Last Days…

When the disease progresses to an irreversible state and keeps worsening, the patient may gradually reduce his/her food intake, lose appetite, have difficulty swallowing and lose weight . These are all normal.

At this point, eating can no longer prolong the life of the patient or reverse the condition. Therefore, it is recommended not to force the patient to eat. This will not only increase the patient’s physical and psychological burden, but also increase discomfort and various symptoms, making the patient feel even worse.

Family members should respect the wishes of the patients and prepare what they want to eat based on their preferences. If the patients refuse to eat in the last days of their life, the family members should respect patients’ wishes to allow a more comfortable and peaceful process of passing.

If the patient does not want to or cannot eat anymore, family members can show their love and care in other ways, such as:

  • Apply some moisturizing cream to the patient’s skin
  • Moisten the patient’s mouth with water
  • Give gentle massages
  • Chat about everyday life and old memories, listen to music or watch TV
  • Spend some time together in peace

To the Family and Carers: Take Good Care of Yourself

It takes a lot of mental energy to keep the patient company and take care of him/her. Family or carers may sometimes feel worried and exhausted physically and mentally. Therefore, it is necessary to take good care of yourself so that you have the energy and physical strength to care for the patient. Here are some suggestions:

  • Maintain a balanced and adequate diet
  • If possible, arrange some time for exercise or a walk
  • Try to take a break
  • If you feel physically or mentally exhausted, ask your friends or relatives to take over for a short time, so that you can take a break

Consult social workers or healthcare professionals for assistance in case of any difficulties or worries.

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