End of Life Hydration & Nutrition Changes

Loss of desire or ability to eat or drink is one of the most difficult symptoms that many families encounter with a loved one in hospice. At end of life, the needs for nutrition and hydration change. As body systems slow down and undergo changes at end of life, our loved ones require less calories and nutrients, in turn decreasing their appetite along with hydration requirements. The loss of thirst and appetite is a natural progression as the body changes. The body begins to expend less energy, and in turn less food and water is required which may be accompanied by weight loss.  Families often worry that their loved one’s decreased desire or ability to eat or drink is the cause of suffering. In reality, offering hydration and nutrition when a loved one does not feel the desire to do so, may cause complications or increased discomfort. If nutrition or hydration is forced it can lead to bloating, nausea, vomiting, edema, heart failure, and pulmonary congestion. In addition, it has been found that the absence of food and water, the body begins to release endogenous opioids in the brain which can help reduce pain

 

What You Can Do:

• Allow your loved one to determine how often they would like to eat, what they would like to eat, and how much they would like to eat or drink. Do not force food or fluids as this could cause physical as well as emotional discomfort.
• Offer frequent, small meals that are high in proteins.
• Taste may diminish with age, try to season foods differently to make them more appealing to a loved one. Herbs, spices, and citruses are great ways to add flavor. Highly fragrant foods may also be more appealing to those with diminished sense of taste.
• Puree foods if your loved one has a difficult time swallowing.
• Provide frequent oral care to keep the mouth moist and clean.
• Offer, but do not force, ice chips or small sips of water often if your loved is able to safely eat or drink. If your loved one is weak, cups with lids can help to avoid spills.
• Ask your loved one if they are experiencing any nausea or pain frequently.
• If your loved one complains of a metallic taste in the mouth, try using plastic utensils. Hard candies can also help to avoid this taste.

 

Allow your loved one to guide you through the changes and do not actively force or withhold nutrition or hydration measures. If your loved one is still able, discuss their wishes as it relates to nutrition and hydration along with the risks and benefits of providing them. Consult with the hospice team for any questions you may have as we are available 24/7 for support and guidance by contacting us.