Factors associated with dietitian referrals to support long-term care residents advancing towards the end of life

BackgroundDietitians are central members of the multidisciplinary long-term care (LTC) healthcare team. The overall aim of this current investigation is to gain a better understanding of dietitian involvement in LTC resident's end-of-life care via referrals.MethodsRetrospective chart reviews for 164 deceased residents (mean age = 88.3 +/- 7.3; 61% female) in 18 LTC homes in Ontario, Canada, identified dietitian referrals and documented eating challenges recorded over 2-week periods at four time points (i.e., 6 months, 3 months, 1 month and 2 weeks) prior to death. Nutrition care plans at the beginning of these time points were also noted. Logistic mixed effects regression models identified time-varying predictors of dietitian referrals. Bivariate tests identified associations between nutrition orders and dietitian referrals that occurred in the last month of life.ResultsNearly three-quarters (73%) of participants had at least one dietitian referral across the four observations. Referrals increased significantly with proximity to death; 45% of residents had a referral documented in the last 2 weeks of life. Dietitian referrals were associated with the number of eating challenges (odds ratio [OR] = 1.42, 95% confidence interval [CI] = 1.27, 1.58). Comfort-focused nutrition care orders were significantly more common when a dietitian was referred (25%) compared with when a dietitian was not referred (12%) in the final month of life (p = 0.04).ConclusionsOur findings suggest that dietitians are involved in end-of-life and comfort-focused nutrition care initiatives, yet they are not engaged consistently for this purpose. This presents a significant opportunity for dietitians to upskill and champion palliative approaches to nutrition care within the multidisciplinary LTC team. The study describes dietitian referrals to support long-term care residents at the end of life. Referrals increased in prevalence in the last 2 weeks of life and were associated with several eating challenges and palliative care practices. Dietitians are well positioned to champion palliative approaches to care with earlier engagement. image Dietitian referrals increased in prevalence in the last 2 weeks of life for residents living in Ontario long-term care homes. Residents experienced a variety of complex eating challenges that required additional support from a dietitian. Dietitian referrals were associated with the initiation of comfort-focused nutrition care orders. With earlier engagement, dietitians would be well positioned to champion and manage a palliative approach to care among multidisciplinary long-term care teams.