Skip to main content

Food is love, or The fundamentals of Long Term Care



Although I usually think with my stomach, I have been particularly preoccupied with how we feed our most vulnerable elders this week. That’s because my Home Based Primary Care team took up the #ThickenedLiquidChallenge in order to raise our awareness of what we put our patients through. The challenge is admittedly biased to make one hate thickened liquids. Participants have to thicken everything they drink with corn starch until it resembles honey in consistency. Those of us who have fed these products to our patients are well aware that “nectar-thick” liquids are much more palatable (i.e. less disgusting).

It has been fascinating to watch a transformation take place as we accept the challenge. Our dietitians are speaking up in team meeting. They are questioning whether or not thickened liquids are consistent with our patients’ goals and wishes. We care for patients at home, so we are well poised to ask this question. HBPC can even bring a provider and the RD out together on a house call in order to discuss the lack of medical evidence about risks and benefits. More importantly, we can sit in the kitchen and address what we definitely know about the burdens of gagging down thickened liquids and the burdens of attempting to enforce a “chin tuck” when feeding thin liquids to a person who has dementia. This is not just patient centered care, it is family centered care.

I’m also a nursing home doc who has taken care of SNF patients for a decade, so I was delighted to see that this week’s Journal of the American Medical Directors Association (JAMDA) has published a special research agenda to improve food and drink intake in nursing homes. It was even more exciting to see an exhaustive literature review of the research, such as it is, about increasing fluid intake and decreasing dehydration. They found modest evidence that dehydration was reduced when nursing home residents had a greater choice of things to drink, when staff were made aware of the need to encourage fluids and became more involved assisting with drinking and toileting. Not surprisingly, it concludes with a plea for well-designed studies.

Getting back to the thickener question, we need well-designed studies that examine quality of life, incidence of pneumonia, and hydration status before and after we choose to abandon thickened water. Qualitatively, I can tell you that my patients with dementia so severe that they were wheelchair bound appeared much happier when liberated to plain water. So did the ambulatory patients. Shoot, so did everyone. And the only significant aspiration I’ve ever witnessed involved a desperate theft of a big hunk of meat from a neighbor’s plate. To be fair, giving plain water carries burdens for help dysphagic patients to drink. After 15 minutes of saying “tuck your chin” before every swallow, I get twitchy with frustration, yet that is what is needed to reduce coughing and sputtering. If I had to choose between my own impatience and my patients’ happiness, I choose their happiness. No question.

At the end of the day, food is love. Drink is no different. It hurts us in subtle ways when we force people to eat and drink the things they hate. We often demonstrate affection through the food and drink we give to those who we love. When the Speech Pathology report comes back showing high risk of aspiration, we should put that love on the table as we discuss goals of care and the burdens of treatment.

by: Theresa Allison


Note: This post is part of the series on the #ThickenedLiquidChallenge.  To watch the videos of this challenge go to our original post here, or check out the videos on YouTube:

Comments

Anonymous said…
As a registered dietitian who has worked in long-term care for over a decade I appreciate your post! It is heartbreaking to hear someone beg for simple plain water especially when there isn't clear evidence of harm. Food is love and I think this conversation is important! Thank you!

Popular posts from this blog

The Future of Palliative Care: A Podcast with Diane Meier

There are few names more closely associated with palliative care than Diane Meier.  She is an international leader of palliative care, a MacArthur "genius" awardee, and amongst many other leadership roles, the CEO of the Center to Advance Palliative Care (CAPC).  We were lucky enough to snag Diane for our podcast to talk about everything we always wanted to ask her, including:
What keeps her up at night?Does palliative care need a national strategy and if so why and what would it look like?The history of CAPC and the leadership centersAdvice that she has for graduating fellows who want to continue to move palliative care forward as they start their new careersWhat she imagines palliative care will look like in 10 or 15 years?What is the biggest threat facing palliative care? So take a listen and if you want to dive a little deeper, here are two articles that we discussed during the podcast:
A National Strategy For Palliative Care. Health Affairs 2017Palliative Care Leadership…

Elderhood: Podcast with Louise Aronson

In this week's podcast we talk with Louise Aronson MD, MFA, Professor of Geriatrics at UCSF about her new book Elderhood, available for purchase now for delivery on the release date June 11th.

We are one of the first to interview Louise, as she has interviews scheduled with other lesser media outlets to follow (CBS This Morning and Fresh Air with Terry...somebody).

This book is tremendously rich, covering a history of aging/geriatrics, Louise's own journey as a geriatrician facing burnout, aging and death of family of Louise's members, insightful stories of patients, and more.

We focus therefore on the 3 main things we think our listeners and readers will be interested in.

First - why the word "Elder" and "Elderhood" when JAGS/AGS and others recently decided that the preferred terminology was "older adult"?

Second - Robert Butler coined the term ageism in 1969 - where do we see ageism in contemporary writing/thinking?  We focus on Louise's…

Psychedelics: Podcast with Ira Byock

In this week's podcast, we talk with Dr. Ira Byock, a leading palliative care physician, author, and public advocate for improving care through the end of life.

Ira Byock wrote a provocative and compelling paper in the Journal of Pain and Symptom Management titled, "Taking Psychedelics Seriously."

In this podcast we challenge Ira Byock about the use of psychedelics for patients with serious and life-limiting illness.   Guest host Josh Biddle (UCSF Palliative care fellow) asks, "Should clinicians who prescribe psychedelics try them first to understand what their patient's are going through?" The answer is "yes" -- read or listen on for more!

While you're reading, I'll just go over and lick this toad.

-@AlexSmithMD





You can also find us on Youtube!



Listen to GeriPal Podcasts on:
iTunes Google Play MusicSoundcloudStitcher
Transcript
Eric: Welcome to the GeriPal Podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: Alex, I spy someone in our …