Many people associate food and beverages with comfort. In many cultures, food is not only a comfort thing, but it can also have spiritual meaning, and is viewed as a means for healing. Because of these associations with eating and drinking, it can be especially disturbing for families when their loved one isn’t consuming what they used to. If you are caring for a loved one who has a life limiting illness and they are no longer desiring or able to take food or fluids, then read on as we discuss what to do when that time comes, what it means when a loved one stops eating or drinking while in hospice, and what some of the reasons they may not want to eat or drink.
How To Support A Loved One On Hospice When They Stop Eating And Drinking
If a loved one has been showing a decline in eating and drinking, it is important to discuss this with the Hospice Nurse to assess ways to support the patient. If symptoms such as loss of appetite or nausea are the cause, then the Nurse will look for ways to alleviate the symptoms and restore appetite. If a patient has stopped eating due to a decline in health and is advancing toward the end stage of the dying process, the Hospice Nurse will discuss practical ways for caregivers to continue to provide comfort to their loved one.
Providing Good Oral Hygiene
If a patient has reached a place where oral intake is no longer possible or desirable, there are practical measures that can easily be implemented to ensure the patient remains comfortable. One very important consideration for the hospice patient who is not having frequent oral intake is their oral hygiene. When eating and drinking is drastically reduced or has stopped, the mouth and lips can become dry. One way that a caregiver can provide comfort to the patient is by keeping the mouth area moist. A lip balm applied often to the lips will help prevent them from drying out. Gentle sponging or wetting the inside of the mouth with a soft moist cloth regularly is another way to offer comfort.
In the instance that the patient has stopped eating but is still able to swallow and wishes to do so, ice chips, popsicles, or small amounts of fluids offered on a spoon can help keep the mouth moist.
What Does It Mean When A Hospice Patient Is No Longer Eating Or Drinking?
So many questions swirl in the minds of families as they care for a loved one who is facing the end of life. As each day passes and a new symptom or issue arises, stress levels and emotions may run high. Caregivers worry that the patient is starving, or suffering pain or discomfort if they no longer eat or drink. Families may wonder how long a loved one lives without eating or drinking.
The answer to the questions above has a wide range because it depends on what stage of the dying process a patient is in. In the early stages of the dying process, a patient may wish to have a meal or a beverage, but may have stopped eating or drinking due to appetite fluctuations, medication side effects, or emotional issues such as depression. If symptoms are resolved, it is possible to increase their intake if the patient desires to do so.
However, in the end stage of the dying process, it may no longer be possible for your loved one to consume food or drink. This can be due to the disease process interfering with swallowing, digestion, and elimination. As a patient approaches the final days to hours prior to death, they may enter into a coma-like state making oral intake a choking and aspiration risk. Hospice is a valuable source of support when navigating sensitive issues such as this. As decreased oral intake is often a sign of declining health, it is important to have the caring, and compassionate support of the hospice team to ensure your loved one receives the care they need at each stage.
Once a patient is no longer awake, alert and able to chew, swallow and drink, the question arises of what to do about it? Should a hospice patient have artificial means of nutrition or hydration at the end of life? Let’s discuss it.
What Is Artificial Nutrition And Hydration?
If a patient has stopped eating or drinking at the end of life, it can be difficult, but it is a natural part of the dying process. As physical activity slows down, nutritional needs decrease as well. Another important process, digestion and elimination, also becomes sluggish causing constipation, nausea and vomiting. Continuing to feed a patient who has stopped eating on their own can cause discomfort, bloating, nausea, vomiting and risk of choking and aspiration. Speak to your health care professionals to determine what the best course of action is for your loved one.
NG tubes, PEG tubes and IV’s are all forms of artificial nutrition and hydration.
NG tubes are a temporary way to introduce nutrition that travels through a tube that is inserted into the nose, down the throat and is passed into the stomach. If long term artificial nutrition is required, a PEG tube would be required for that. A PEG tube is inserted directly into the stomach from an incision made in the abdomen. Whether an NG or PEG tube is used, both can lead to issues such as bloating, nausea, vomiting, diarrhea, ulcers, infection and fluid overload.
Artificial hydration is usually offered via IV which is a small flexible catheter that remains in the vein after insertion with a needle. The needle does not remain, only the small plastic catheter tube. It is important to note here again, that while it can seem distressing if a loved one is not drinking fluids, oftentimes, they are more comfortable as gastric juices are decreased which in turn may reduce nausea and vomiting.
Loss Of Appetite
Medications are one cause of loss of appetite, especially if they cause nausea or vomiting. Some drugs can cause dry mouth, altered taste perception, increased drowsiness, irritability and even constipation. These types of side effects can cause a patient to decline meals and even liquids. Often if these side effects are resolved, a patient who is able may return to eating and drinking as they had been.
If loss of appetite is due to a mechanical issue such as a tumor, or after a surgical procedure, recent chemo, or even cancer, it may be more difficult to restore appetite. It is important to assess the patients changing dietary and fluid intake needs frequently to offer any assistance possible.
Declining Health
Generally, as a patient begins to have a decline in health, their level of activity decreases. With less physical activity, the body often requires less intake for energy production and the appetite naturally is decreased. Additionally, if the patient has a decrease in cognition, or even loss of effective swallowing and digestive processes, eating and drinking may stop completely. As discussed above, if a loved one on hospice has stopped oral intake, it is important to work with the hospice team to ensure that your loved one is supported, has good oral hygiene, and that comfort goals are being met.
Las Vegas Hospice Care
If you or your loved one is seeking support for end of life care in the Las Vegas area, Siena Hospice can help. You do not have to face a life-limiting illness alone. Supporting families with excellence in hospice care is the heart of what we do. Please contact us as our caring Hospice Team is ready to answer any questions you may have.