When a Hospice Patient Stops Eating or Drinking
Few things are harder than watching a loved one slip away because of a life-limiting illness. The experience is even more challenging when family members and cuidadores notice that their hospice patient stops eating and drinking at the end of life.
Families may worry:
- Are we giving up on our loved one if we don’t try to feed them or offer water/fluids?
- What is our loved one's chance of survival without water or food in hospice care? How long can a hospice patient live without food and water?
- Our family traditions revolve around food and drink as symbols of loving care. Are we taking away the love if we take away nutrition and hydration? Are we letting our loved one starve to death?
- Will withholding food and water at the end of life cause pain for our loved one?
- What can we do to make sure our loved one does not suffer?
Be Guided by the Body’s Gradual Decline
A dying patient's needs for food and water are far different from those of a healthy, active person. As the end of life nears, the body gradually loses its ability to digest and process foods and liquids. As organs and bodily functions shut down, minimal amounts of nutrition or hydration/liquids might be needed, if at all.
Continuing to offer food and water, or opting for artificial nutrition or hydration (ANH)—such as nasal (NG) or stomach (PEG) feeding tubes or IV fluids for hydration—can actually complicate the dying process and lead to other health problems.
VITAS healthcare always works with patients and families to develop individualized care plans that support the patient’s wishes and values, and those plans include a discussion about the role of artificial nutrition and hydration.
Acknowledge Potential ANH Complications
End-of-life patients who are fed through artificial means can suffer from gagging, tube complications (e.g., blockages or infections), discomfort, aspiration pneumonia, pressure sores, bloating and a sense of "drowning" or feeling "trapped." Moreover, studies have shown that artificial nutrition has very little impact on survival for hospice patients. For example, studies show that dementia patients who are tube-fed have no different life expectancy than those who are slow hand-fed.
Craft and Honor a Compassionate End-of-Life Care Plan
Ideally, decisions about care near the end of life are made while everyone is healthy and able to speak their minds. That's when an advance directive should be written and shared with family and healthcare professionals.
The reality is that decisions are often put off until the patient is no longer able to communicate their wishes, leaving family members and a knowledgeable healthcare team to make decisions. Hospice professionals can offer specific types of care and support around nutrition and hydration for your loved one as death nears:
- The hospice team will continue to relieve pain and manage symptoms
- The family’s personal, cultural and religious beliefs and values around nutrition and hydration will be honored
- Family members and caregivers will be taught how to manage thirst and hunger compassionately and without artificial means in a patient’s final days of life
- In the final weeks, days and hours of life, families will be reassured that the patient’s decline and ultimate death is due to the progression of the underlying disease process and not the natural decreasing and ultimate cessation of eating and drinking.
The Challenge of Feeding Tubes
Hospice services will not be denied to a patient who already has a feeding tube in place. The hospice team will work closely with the patient, family and caregiver to decide whether to continue to use the tube. While a feeding tube technically can be removed, most often the decision is made to just stop using it.
Feeding tubes typically are not placed in a patient who is terminally ill. But all necessary steps are taken to ensure comfort and pain relief as the end of life nears. In rare circumstances, the VITAS team might administer IV fluids temporarily to prevent dehydration or provide comfort, but feeding and drinking will primarily be done by mouth.
How Family Members and Caregivers Can Help
A key factor that should guide decisions about nutrition and hydration at the end of life is patient choice. Patients who prefer quality of life at the end of life often want to be unencumbered by tubes and equipment in their final hours, allowing them to be physically close to their family members and able to receive the comfort care they desire.
Family members and caregivers play an important role by supporting a loved one through the dying process:
- If the patient can still eat or drink, offer small sips of water/liquids, ice chips, hard candy or very small amounts of food via spoon. Preste atención a las señales del paciente sobre cuándo detenerse.
- If the patient can no longer drink, keep the lips and mouth moist with swabs, a wet wash cloth, lip balm or moisturizers.
- If the patient can no longer eat or refuses to eat, provide alternative forms of nourishment: conversation, loving touch, music, singing, poetry, humor, pet visits, gentle massage, reading, prayers or other acts of caring and love.