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.
As a 20 year hospice nurse, the common concern I hear from families of our hospice patients is: “I don’t want mom to starve,” or “I really want to get some fluids into dad.”
I completely understand their concern on several levels.
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 of those levels are important, it is the clinical level that is the most easily misunderstood. I want to explain how and why it is not always best to feed and hydrate dying patients.
Nutrition at End of Life
When the body is dying, it is no longer able to regulate fluid well. Fluid imbalances can arise, causing significant symptoms:
Edema, which is swelling, 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. This is 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 turn a bluish color.
However, fluids are not the only thing that can cause problems.
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.
But 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.
DeAnna L. Looper RN, CHPN, CHPCA
Senior Vice President of Clinical Operations
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