Nutrition & Hydration
Eating and drinking are important parts of most cultures and are a way we relate
to each other, particularly within families. One of the most important ways we care
for each other is through offering food and drink.
People who are in the last year of life often lose their appetite; food stops tasting
good and they do not want to eat. Sometimes they can be tempted with favorite foods,
or what we call “comfort foods.” But at some point, they simply will not be able
to eat. This is hard on caregivers who want to provide nourishment, and who may
feel that their loved one would live longer if only they would eat more.
When appetite begins to fail, you as the caregiver can and should offer a variety
of foods. Talk to your loved one about what they think would taste good and let
them know it is acceptable not to have a full meal. They may not want “usual foods”
at “usual times.” Ask the doctor if there are any foods that should be avoided.
For those who have been on restricted diets, ask the doctor if they can now have
their favorite foods. Foods previously avoided for health reasons (e.g. foods high
in cholesterol) may now be acceptable.
Offer small portions and do not force them to eat. Make sure water or other drinks
are available and remind them to drink, as they may not feel thirsty. Remember that
there are many ways to show you care that do not involve food and drink.
Sometimes, people with serious life-threatening illness will make a specific choice
to stop eating or drinking; this is different from the natural decrease in appetite
discussed above. If this happens, you will want to consult a physician, who may
suggest counseling. It is important to be sure that any decisions made are well-considered
and not the result of treatable depression or anxiety.
Tube feeding and intravenous or subcutaneous fluids
One difficult decision you may confront as a caregiver is whether to provide your
loved one with artificial nutrition (tube feeding), or liquids delivered via needle
into the bloodstream (intravenous or subcutaneous fluids.) Artificial nutrition
and hydration may supplement or replace ordinary eating and drinking by giving a
chemically balanced mix of nutrients and fluids through a tube placed directly into
the stomach, the upper intestine, or a vein.
Short-term artificial nutrition and hydration can save lives in cases where a person
has a curable illness or has suffered an accident and needs help to take in nutrition
until the body heals.
The use of tube feeding has pros and cons, however, when used for people with end-stage
conditions. Nutritional treatment may help to keep up energy levels if the person
otherwise is feeling well or wants to be able to participate in a specific event—like
a wedding or a holiday celebration. But nutritional treatment alone will not reverse
the course of the disease. For individuals who have trouble swallowing, as often
happens with Alzheimer’s disease or other dementias, tube feeding may increase the
risk of pneumonia because the liquid food may unintentionally get into the lungs.
Similarly, artificial hydration has pros and cons. For people who cannot swallow
or who cannot “keep anything down,” but have otherwise good organ function, intravenous
delivery of fluids can be essential to maintaining the function of the brain and
other critical organs. But for people whose organs are not functioning well, particularly
those who are having heart, lung and/or kidney problems, delivery of intravenous
liquids can put more strain on these organs, causing even more difficulty.
You may be worried that not eating or drinking would cause discomfort, but studies
show that for persons in the final phase of illness, going without food and fluids
is not painful. The fact is that people at the end of life who have stopped eating
and drinking naturally, or by choice, do not complain of thirst or hunger. In fact,
there is a side effect of going without food and fluids in which metabolism changes
produce a mild sense of euphoria and calm.
For people who are not eating or drinking, it is standard care to apply moisture
in some form to the lips and mouth regardless of whether or not the dying person
is ever able to swallow again. You can use a moistened cloth or swab. In fact, application
of moisture to the lips is comforting even for people who are able to drink fluids.
Some religious traditions require that people not be denied food and drink, so artificial
nutrition and hydration may be important from a religious perspective for your loved
one or for you. A decision to start or stop tube feeding or intravenous fluids should
be discussed with your loved one whenever possible, so that their wishes can be
expressed and honored. The decision should also be discussed with family and health
care professionals so that you can be as comfortable as possible with the decision.
Copyright 2008 Hospice Foundation of America. All Rights Reserved.
