Guidelines for a Palliative Approach in Residential Aged Care

Another study explored whether the fluid intake of 130 incontinent residents could be
improved using a behavioural intervention that consisted of verbal prompts and beverage
preference compliance [209] (Level III-1). The authors’ reported that the intervention was
effective in increasing fluid intake for most of the residents; however, different approaches were
required depending on the resident’s severity of the cognitive impairment. For example, verbal
prompting alone increased fluid intake for those with more severe cognitive impairment, but
the same result was not found for those with less impairment who only increased their fluid
intake when they received their preferred drink.
The decision regarding rehydration should focus on the resident’s unique circumstances,
including the wishes of the resident and his / her family [204,210 ] (Level IV; Level EO). The
comfort of the resident is the primary goal, rather than providing optimal hydration [185,190]
(Level IV; Level QE). Factors important to family members when considering artificial
hydration are issues of symptom distress, ethics, emotional considerations, information
exchange and culture [211] (Level QE). A timely discussion that includes family members, the
aged care team, and where possible the resident is required with the aims being to: [211]
• attempt to determine the resident’s and his / her family member’s wishes and preferences
regarding artificial hydration;
• provide information about the pros and cons of artificial hydration, including any limitations
in our understanding about this process;
• recognise and explore family members concerns that they might have that have not been
spoken.
For each resident, the solutions and decisions will vary; however, some key principles are listed
in the following table that can guide the resident, the family and the aged care team in making
decisions in this situation.
Table 13: Principles to guide discussions and decisions regarding hydration [206]
In planning for care, and introducing a palliative approach, explore with resident and family their wishes
in the event that the resident is not being able to maintain hydration. These wishes should be clearly
documented and regularly reviewed over time with the resident and family.
• Identify cause(s) for inability to maintain hydration.
• Where possible, and if the resident wishes, treat reversible causes.
• Review the resident’s prognosis and the goals of treatment.
• Assess whether the decrease in intake is having a negative impact on quality of life.
• Consider simple non-invasive interventions first.
• In the event a more invasive intervention is considered necessary, establish review time lines and
indications for withdrawal before commencing therapy.
• Regardless of the interventions instigated, oral discomfort can be treated with good oral care.
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