Guidelines for a Palliative Approach in Residential Aged Care

group (n = 35; received acupressure 3 x weekly for 4 weeks plus usual care) had significantly
lower levels of fatigue (as measured by the Revised Piper Fatigue Scale [1998]) than the control
group (n = 36, received usual care) [175] (Level III-1). Interestingly, there were no significant
differences between the acupressure group and the sham group (n = 35; received sham
acupressure [massage with no acupoints] 3 x weekly for 4 weeks plus usual care), with both
these groups having decreased fatigue levels post-intervention. These findings appear promising;
however, further studies are required with significantly older participants to determine the
appropriateness of this therapy.
Guideline:
Fatigue
Ref No.
Evidence level
20. Fatigue is the most frequently reported physical concern by
individuals nearing death. Therefore, careful assessment is
required of factors that may indicate or bring about fatigue (e.g.
depression, anxiety, pain, a reduction in intermediate activities
of daily living, and number of medications), which will enhance
early identification and management of fatigue.
164
170
IV
QE
6.4 NUTRITION AND HYDRATION
Nutritional and hydration issues for residents receiving a palliative approach are complex and
raise ethical questions for the aged care team, residents and family members (see Chapter 4,
‘Advance care planning’). A palliative approach endeavours to address these issues in the light of
the best available evidence.
Nutrition and hydration are associated with more than physiological need. There are many
psychosocial, cultural and symbolic meanings that influence the reasons for poor nutritional
status [176] (Level II). For example, the sharing of meals is usually associated with social
gathering, communication and life time habits such as when, where and how we eat [177] (Level
EO). Therefore, if residents are unable to eat or share a meal or drink with others the experience
of meal times can be extremely unpleasant and can contribute to refusal to eat. Refusal to
eat or drink can also occur when a resident does not like the food or fluid being offered (i.e.,
therapeutic diets often lack taste [178] ), needs assistance or extra time to eat, [179] or when the food
or fluid is inappropriate to the resident’s cultural background. [177]
6.4.1 Nutrition
There is no agreement regarding the definition for malnutrition or under-nutrition (either term
can be used) [176] (Level II). However, it is generally accepted that malnutrition is “… a state of
energy, protein or other specific nutrient deficiency that produces a measurable change in body
function and is associated with worse outcome from illness as well as being specifically reversed
by nutritional support”. [180, p. 590] Malnutrition is a medical condition determined by chemical
tests and is usually treated by medical intervention. Thus, it should not be confused with
hunger, which is not considered a medical condition. The most common nutritional problems
for residents in RACFs are weight loss and associated protein energy malnutrition [176] (Level II).
Guidelines for a Palliative Approach in Residential Aged Care 87