Exploring end-of-life nutrition care for residents of long-term care: A retrospective chart review

This study explores the intersection of nutrition care and end-of-life decline among long-term care residents. Challenges with eating and nutrition can cause stress for both residents and care partners. The aim of the study is to describe various aspects of the nutrition care experience for residents in the final months of life to support decision-making and inform future directions for developing best practices for end-of-life nutrition care.

Data were collected from progress notes and care plans documented in resident charts of 164 deceased LTC residents from 18 long-term care homes across southern Ontario. The main findings include:

• Likelihood of severe and complex eating challenges (e.g., poor appetite, swallowing difficulties, refusing to eat, decreased food intake) increased in the month preceding death.
• Nearly all (99.4%) of the residents in our sample required interventions (e.g., physical assistance, oral nutritional supplement) to support food intake within the last 6 months of life. However, comfort-focused nutrition orders, which specifically prioritize the resident’s comfort over the nutritional value of food, were initiated for less than one third of residents and most often within the last 2 weeks of life, highlighting a potential opportunity for future development.
• Dietitian referrals were common (73% of participants) in the last six months of life and were significantly associated with number of eating challenges and higher frequency of comfort-focused nutrition care orders in the final month of life, presenting a significant opportunity for dietitians to upskill and champion comfort-focused approaches to nutrition care within the multidisciplinary LTC team.