A cultural exploration of aging veterans: The meaning of food and beliefs regarding artificial nutrition at end -of -life

Withdrawal or withholding of artificial nutrition is rife with symbolism and emotion. The purpose of this study was to elicit the meaning of food and values and beliefs concerning nutritional treatments in aging veterans, in terms of the role that cultural models may play in defining this unique cohort. This descriptive study, using cognitive anthropology, included data from freelists and semi-structured interviews, and recruited male veterans 65 years of age or older with terminal diagnoses or advanced, progressive, incurable illnesses. Major findings of this study included the use of analogous reasoning to make sense of artificial nutrition and end-of-life, and emergence of life stories through food. Most importantly, aging veterans considered appropriate for palliative care shared beliefs concerning the meaning of food, “tubes,” and living and dying, resulting in the development of three cultural models: (1) a model of community identity and social memory, (2) a model of “tubes” created through image schemas, and (3) a model of living and dying focused on control for end-of-life nutritional decisions. Study findings highlighted the absence of knowledge and experience concerning artificial nutrition, and the need for adequate teaching strategies using informants\u27 image schema of “tubes” as a basis for artificial nutrition. Findings also confirmed the need for effective and sensitive end-of-life discussion, requiring adequate time, support, and provider self-evaluation concerning end-of-life care. APNs may view end-of-life status differently than physician colleagues, creating confusion for patients. A practice perspective focused on multidisciplinary and collaborative efforts for those with terminal or advanced progressive illnesses would provide opportunities for optimal patient care. Results of this study highlighted the need for further research focused on the use of artificial nutrition terminology and a treatment specific focus on enteral or parenteral nutrition. This research will empower providers to deliver compassionate, well-informed, end-of-life care in a country still recovering from shock waves created by the life and death of Terri Schiavo