Food and Water at end of life

Document created by Mary Aycock Employee on Jan 6, 2017Last modified by Mary Aycock Employee on Feb 7, 2017
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The body goes through many changes during the dying process. Almost every terminally ill patient has loss of appetite and weight. Decreased interest in food and water is one of nature’s ways of allowing a person to die more comfortably and peacefully. Like other aspects of care, nutrition involves physical, emotional and spiritual issues for each patient and family member. This information will help you discuss your questions with your medical provider and cope with these issues with confidence and compassion.

 

When patient says

“I am eating but still losing weight.”


What is happening

More calories are used because of the rapid growth of cancer cells. Some chronic illnesses increase the body’s metabolism, using more calories.

 

What to do

Have a positive attitude about the amount of food the patient is able to eat. Talk to your nurse or medical provider about ways to increase calories of food the patient eats. Focus on patient’s comfort instead of weight.  

 

When patient says

“I have no appetite.” Or “I don’t like the foods I used to like.”


What is happening

Fewer calories are needed as some diseases progress. Cancer cells may produce chemicals that decrease appetite or change taste. Some medications may decrease appetite.

 

What to do

Offer small amounts of food several times a day. Do not insist if patient says he cannot eat. Discuss with your nurse or medical provider if any medications may be affecting appetite.  

 

When patient says

“It hurts when I swallow or eat.”


What is happening

Many patients develop white spots or patches in the mouth and throat, which may cause painful swallowing or eating. Mouth and tongue may become dry because of medication or decreased fluid intake.

 

What to do

Notify your nurse or medical provider if you see white patches in the mouth or if the patient complains of painful swallowing. Keep mouth and lips moist with crushed ice, sips of water or lip balm. Fill small spray bottle with water, spray mouth and tongue as needed. Provide frequent mouth care with Toothettes® or toothbrush. Avoid mouthwashes with alcohol.

 

When patient says

“When I eat or smell food I become nauseated.”


What is happening

The body’s ability to digest food decreases as some diseases progress. Anxiety, pain or constipation may increase nausea. Chemotherapy or radiation may increase nausea and vomiting. Some medications may cause changes in taste or smell.

 

What to do

Discuss with your nurse or medical provider medications to control nausea and vomiting. Take pain, anxiety and bowel medications as ordered. Reduce cooking smells by using exhaust fans; covered pans or bringing cooked food in. Offer cool foods. Avoid greasy or spicy foods. The final choice of what food to eat is the patient's.  

 

When patient says

“I’m hungry, but I fill up fast.”


What is happening

Tumors may press on the stomach or other internal organs, leaving less room for food. Digestion slows and food can stay in the stomach longer. Even normal sized meals may increase feelings of bloating and nausea.

 

What to do

Offer small amounts of food several times a day. Do not insist if patient says he or she cannot eat.  

 

When patient says

“My family is afraid I’m starving to death.”


What is happening

Weight loss, weakness and skin color changes are typical. The body cannot process food in the final stages of terminal illness. Decreased interest in food and water is one of nature’s ways of allowing a person to die more comfortably and peacefully.

 

What to do

Offer food and liquids but do not force. Focus on patient’s comfort instead of weight.

 

When patient says

“I feel guilty because my family feels like I’m giving up.”


What is happening

Sharing food is an important part of our culture. Caregivers often feel helpless when the patient cannot eat. The body’s need for food decreases as the disease progresses. Low food intake does not cause hunger or discomfort. If the patient eats more than he desires it may cause increased discomfort. Not eating is a reminder that the disease is progressing.

 

What to do

Offer food and liquid, but do not force. Focus on patient’s comfort instead of amount of food eaten. Do not insist if patient says he is not hungry or cannot eat.

 

When patient says

“What about tube feeding or IV fluids?”


 

What is happening

In the early stages of illness, tube feeding and IV fluids may have been helpful. The body’s need for food and fluid decreases as the disease progresses. The body cannot process fluid or food in the final stages of illness. Giving IV fluids and tube feeding may increase discomfort, such as nausea, vomiting, swelling and breathing difficulties. Dehydration is not painful; it is one of nature’s ways of allowing a person to die comfortably and peacefully.

 

What to do

Keep mouth and lips moist with crushed ice, sips of water or lip balm. Fill small spray bottle with water, spray mouth and tongue as needed. Provide frequent mouth care with Toothettes® or toothbrush.

 

 

As the need for food and fluid decreases, the patient and family may be faced with difficult spiritual and emotional decisions. Dying is a natural process and the patient and family have the right to make choices about care. Consider contacting Bluegrass Hospice Care for help during this time in a person's life.  The hospice nurse, social worker and chaplain are there to support you as you face these issues.

 

 

 

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