Responsible nutrition therapy in palliative care

Abstract

The purpose of this study was to begin to fill the void regarding nutriologic status in patients with Congestive Heart Failure (CHF) and or Chronic Obstructive Pulmonary Disease (COPD) receiving palliative care, and to bring the quality of palliative care to a more appropriate level as related to nutritional injury. Objectives: The objectives were: 1) to determine the prevalence of patients with a stage of nutritional injury at or above the clinical horizon; 2) to determine the response, specifically changes in biochemical parameters and physical manifestations of nutrient based lesions, after micronutrient intervention; 3) to determine if there is a relationship between micronutrient intervention and macronutrient intake; 4) to determine if there is a positive relationship between micronutrient intervention and stage of nutritional injury regardless of the percent of estimated non-protein calorie and protein needs consumed and 5) to ascertain what characteristics identify patients without resiliency / response to treatment. Design: The design was a prospective theory-based effectiveness trial exploring nutriologic status and response to micronutrient intervention utilizing a quasi-experimental design. Twenty-six Veterans with CHF / COPD admitted to the Nursing Home Care Unit for palliative care or designated as Advanced Disease were enrolled; nineteen completed the study. Subjects were recruited consecutively and comparisons were made between baseline and post-treatment values. Methods: A Minimum Data Set structured nine-step nutritional care process including evidence, diagnoses, etiologies, goals / predicted outcomes, interventions and actual outcomes was utilized. Results: All subjects presented at or above the clinical horizon of nutritional injury at baseline representing acquired nutritional loss; 84% had lesions suggestive of nutrient imbalance. Prevalence of pyridoxine, thiamin and zinc deficits were 63%, 11% and 21% respectively. Pyridoxine status following treatment improved significantly, p = .000. Fifty-three percent of subjects had improved outcomes indicating nutritional resiliency, and change within stage of injury. Factors observed in suboptimal nutritional resiliency included drug-nutrient interactions and acute infection. Conclusions: The nutritional cost from lack of responsible nutrition therapy is likely to be significant in veterans with CHF/COPD receiving palliative care. Drug-nutrient interactions and acute infections are most likely the offending factors interacting with the resiliency state.