Exploring End-of-Life Nutrition Care for Residents of Long-Term Care: A Retrospective Chart Review

Introduction: Eating challenges are prevalent in long-term care (LTC) and have been associated with mortality, particularly in older adults with advanced conditions such as dementia. However, changes to eating habits and nutrition care practices to support LTC residents who experience difficulties with eating have not been described within the context of end-of-life decline. Despite a general move towards palliative approaches to care in LTC, research on the implementation of comfort-focused nutrition care practices is lacking to date and the implications of a palliative approach to nutrition care is unknown. Nutrition care is an ideal target for palliative-focused initiatives because of the deeper meaning often placed on food and mealtimes as symbolic of relationships and care and the additional emotional challenges associated with health decline and death. When poorly addressed, severe eating challenges can cause distress among residents and care partners and contribute to decreased quality of life for residents and care providers. As such, best practices to support residents with severe eating challenges moving towards the end of life are needed to maintain quality of life for residents and provide positive care experiences for care providers, but the end-of-life nutrition care experience must first be understood. Towards this end, this dissertation aims to describe longitudinal changes in various aspects of the nutrition care experience for LTC residents approaching the end of life. Methods: Data for this study were obtained from a retrospective resident chart review of a convenience sample of deceased residents from 18 LTC homes in southern Ontario, Canada. Two sampling frames, the “Better tArgeting, Better outcomes for frail ELderly patients (BABEL)” study and a chain of homes were accessed to meet sample size requirements. The latter included random selection of decedents for chart review. Eligible participants were over the age of 65 years at death and living in residence for at least 6 months. Data were collected from electronic charts. Admission forms provided information on demographics (e.g., age at death, sex, length of admission), and resident assessments completed approximately 6 months prior to death provided functional and health characteristics (e.g., cognitive performance, health instability) and diagnoses. Nutrition-related information (e.g., nutrition interventions, eating challenges) were obtained from monthly weight records, progress