End-of-Life Eating Habits: Why It’s OK for Your Loved One to Stop Eating and Drinking on Hospice
We associate food with comfort. Babies bond with their mothers while nursing or being fed a bottle. We give our loved one chicken soup when they are in bed with a cold.
Food is so important to our cultural celebrations and holidays. A colorfully decorated cake and ice cream on birthdays. Turkey and all the trimmings on Thanksgiving. Spiral ham, pecan pies and sugar cookies at Christmas. Sufganiyah and livivot on Hanukah. BBQ burgers, dogs, and ice-cold watermelon on the 4th of July. It goes on and on. For generations, this is how we have shown our family and friends that we care about them.
However, nutrition changes drastically at the end of life. Families of our hospice patients commonly express concerns such as: “I don’t want mom to starve,” or “I really want to get some fluids into dad.” These concerns are deeply understandable for several reasons.
- Personal: Four years ago, my mother died. She was admitted to a rural hospice service after a lengthy illness. She had gone five days without food or fluids. My siblings and I were at her bedside when she took her last breath. I have to admit, even knowing the clinical implications of forcing food or fluids at the time of death, I struggled to make the decision.
- Emotional: It is difficult to think that we may be allowing our loved ones to feel hunger or thirst. Caregivers wonder: Am I going to feel guilty after it is all said and done?
- Clinical: During a terminal illness, providing food or fluids late in the dying process can actually be worse for our loved one.
While all those levels are important, it is the clinical level that is the most easily misunderstood. I want to explain why end-of-life patients stop eating, and why it’s OK to stop nutrition and hydration at the end of life.
Why do end of life patients stop eating?
It’s normal for people nearing the end of life to have a diminished appetite. This happens as the body’s ability to digest and metabolize foods and fluids gradually decreases. As the final stages approach, the digestive system shuts down, and there is little need to process food and energy.
If not already, your loved one should go on hospice care. This service is intended to help improve the patient’s quality of life at the end, typically translating to more quality time with family and friends and less ER and hospital visits. Crossroads Hospice & Palliative Care can perform an assessment for hospice eligibility at any time.
What happens when a hospice patient stops eating and drinking?
While it’s natural for hospice patients to stop eating and drinking when nearing the end of life, there are certain changes that can occur. Various physiological changes happen as the body’s metabolism slows down. As the patient’s condition deteriorates, they may experience fatigue and weakness. They may even experience changes in consciousness, including drowsiness, confusion, or coma.
At this stage, it’s essential for caregivers to provide supportive care to ensure the patient’s comfort and dignity. This may involve offering oral care to keep the mouth moist, providing medications to alleviate symptoms like pain or nausea, and offering emotional support to both patients and their loved ones. Your hospice provide should be able to answer any questions or assist with such care.
How Long Do Hospice Patients Live Without Eating?
Hospice patients can live for varying lengths of time without eating, typically ranging from a few days to several weeks. For most individuals, this period lasts about 10 days, although there can be exceptions. In rare instances, some patients may survive for several weeks without food intake.
Why you should never force fluids at end of life.
When the body is dying, it is no longer able to regulate fluid well. Forcing fluids can cause imbalances, leading to significant symptoms like edema. Edema is swelling that can occur in the feet, legs, and hands. This can make it harder for the body to fight infections or heal wounds. But worse, it can cause swelling in the lungs, called pulmonary edema.
Pulmonary edema can cause distressing symptoms such as shortness of breath, coughing and even the inability to get enough oxygen into the blood, which is known as hypoxia. Hypoxia can cause our loved ones to become confused, agitated and even combative. Their skin color can even turn a bluish color.
Why you should never force food at end of life.
Feeding our loved ones during this time can cause just as many problems. Forcing someone to eat can cause choking or aspiration. This is when the person “inhales” food or fluids into the lungs. This can be painful. It can cause many of the same symptoms such as shortness of breath and coughing. Feeding our loved ones at this time can also cause other problems such as nausea and vomiting, abdominal bloating, excessive gas, constipation or even diarrhea.
This can be especially painful to a person who is in the process of dying. Think of how it feels to be bloated or nauseous when you are completely healthy. For a person who is dying, it is much worse.
It’s OK for hospice patients to stop eating and drinking.
Caregivers and family should not worry that their loved one is starving and thirsty. The reason? Simply put, the body is amazing! It has learned during the dying process to reduce and eventually, totally eliminate the need for fluids and food. The body has begun to shut down and prepare for the end.
Therefore, trying to make them eat or drink will not comfort them—even though we usually use food as a way to bring comfort to our families. It will actually make their symptoms much worse. As hard as it may be for us, there may come a time when we need to find new ways to bring relaxation and serenity to our family members. Your hospice nurse or healthcare professional can guide you on when it is time to stop offering food and fluids. Just remember, as hard as it may be personally, this is really the best way to show your loved one that you care.
If you need more information on hospice and nutrition at end of life, please call us at 888-564-3405 or visit our website.
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DeAnna L. Looper RN, CHPN, CHPCA |
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