When Your Loved One Stops Eating or Drinking on Hospice Care
Dr. Mayo
Published
December 10, 2024Having a loved one on hospice services is already a difficult experience. It can be even more challenging if your loved one has stopped eating or drinking. You may worry that your loved one is starving or in pain. However, eating and drinking can look very different for patients at end-of-life. These concerns are common, but hospice services can help maintain a patient’s comfort during this time.
Some problems experienced by hospice patients that affect nutritional intake are a decrease or loss of appetite, nausea, diarrhea or constipation caused by delayed gastrointestinal function, heartburn, vomiting and chronic pain. This can make it difficult to find foods that the patient can eat or drink. Family caregivers are met with this change in nutritional intake and, often, they will have the desire to “fix” it. Food and drink should never be forced on a hospice patient.
The best guide in assessing a patient’s food and fluid needs is recognizing their comfort level and honoring their choices. A hospice patient may naturally take in less food and water, and this is normal for someone at end-of-life. It is important to maintain comfort and comply with wishes by not actively forcing or actively withholding nutrition.
Hospice care works to provide support based on the unique needs of each patient. Our clinical teams will assess and create a plan of care for each patient once they are admitted. This will address nutritional management and support for a loved one on hospice.
Loved ones can help by offering smaller portions of food or drink if the patient still wants to eat or drink. Listen or take note of cues from the patient on when to stop. If your loved one on hospice is no longer able to continue eating or drinking, you may use a wet sponge or wash cloth to keep the lips and mouth moist.
Reasons Why a Hospice Patient Chooses Not to Eat or Drink
When a loved one on hospice chooses to no longer eat or drink, it can be alarming. However, this is a very natural part of the end-of-life journey. A loss of appetite is not starvation, and their body will know what to do during end-of-life.
As someone nears the end of their life, the body weakens and begins to conserve the energy normally used to eat and drink. Eating problems and malnutrition are common in terminally ill patients. The digestive system slows down and the body does not need many nutrients or can’t absorb them, so it stops asking. It is common that appetite reduces, and the patient becomes increasingly fatigued. It is important to understand this is a natural part of the dying process and the patient is NOT suffering or in pain. A conscious decision to give up food can be part of a person’s acceptance that death is near.
Some additional physical changes in someone nearing end-of-life may be reduced appetite, reduced thirst, sleepiness, unresponsiveness or weight loss.
Management and Support in Hospice Care
St. Croix Hospice will provide a dietitian if needed for a patient’s plan of care. St. Croix Hospice will admit patients with a feeding tube, if appropriate.
A patient who has stopped eating or drinking can still take medications through some alternative ways. Medications may be changed to a liquid or dissolvable tablets. When appropriate, the hospice team may offer versions of medications that do not need to be swallowed.
Navigating certain challenges that come with a loved one who has stopped eating or drinking can be difficult. However, hospice care has the resources and knowledge available to help every step of the way.
How can you help?
Patients who want to eat but are too weak and tired to feed themselves can be assisted with feeding. Be sure to follow the patient’s lead on how much they want to consume. This may be only a few bites/sips or nothing at all. It is important to recognize when the patient has no appetite.
By reading these signs, you can help the patient be more comfortable.
Signs of loss of appetite:
- Patient does not open their mouth
- Spits food out
- Turns head away
- Coughing after swallowing
If patient has difficulty swallowing:
- Alter diet consistencies and thicknesses – thin liquids are more difficult to swallow. Soft or blended foods may be a better option. There are also commercial thickeners available.
- Citrus juices such as cranberry or pineapple may be helpful for patients with excess mucus. Sometimes milk products increase mucus – try a dairy-free alternative.
When appetite decreases:
- Always have snacks available if need arises.
- Shakes, smoothies, or other milk-based drinks can provide a lot of calories without requiring a large intake.
- Do not limit type of food to time of day. Patients should eat whatever they want when it sounds good.
- Try small meals with snacks in between, even if it is just a small bite.
When patient is nauseated:
- Eat small portions frequently.
- Bland foods often go down easier such as soup, crackers, gelatin and fruit.
- Drink liquids between meals instead of at meals. Cold beverages are easier to get down – try Popsicles or flavored ice cubes.
- Stay upright or only slightly reclined, keeping head at least 4 inches above feet for at least two hours after a meal.
If mouth is dry or sore, offer:
- Ice chips
- Popsicles
- Frozen juice
- Mouth swabs
Tips to make meal times more enjoyable:
- Provide the least restrictive diet possible. Diabetic diets or low sodium diets will not benefit the patient at the end-of-life.
- Offer foods and fluids the patient enjoys.
- Serve smaller, more frequent meals.
- Provide softer, easier to chew and swallow foods such as ice cream, pudding and applesauce.
At end-of-life, accepting varying needs for food and fluid as a natural part of the dying process becomes important for both patients and their caregivers. Understanding how to interpret cues from patients can help guide in providing comfort and support. Observing decreased interest in food or difficulty swallowing can signal the body’s transition, indicating it is time to shift focus towards ensuring comfort rather than pushing for nutritional intake. Loved ones should not be making these decisions alone but to always work with the patients care team who can provide the expert guidance needed during this time.
Food is an important part of our lives. We often express our love and concern for others by preparing meals for them. Engaging in meaningful activities like conversation, music, gentle massages or reading aloud can offer comfort and connection in place of food or drinks.
For a patient no longer wanting to eat or drink, doing so may cause additional bloating, nausea and discomfort. No one should ever try to force feed a hospice patient as this can cause distress.
Although it can be concerning to see a loved one stop eating or drinking, it is a natural experience at end-of-life. It is best to use this as a sign to keep your loved one comfortable through other methods of care and to lean on support from hospice care. It is important to trust your loved one’s symptoms and to focus on your loved one’s wishes.
How you want to address things like your nutrition at the end-of-life, are why it is important to share your healthcare and end-of-life wishes with your loved ones before you are on hospice care. Our end-of-life planning program offers a range of complimentary tools, valuable information and training to help you prepare for the future and share information with those who may need it.
Hospice helps people with advanced illness live life to the fullest in the time they have, with a focus on comfort and quality of life. Contact St. Croix Hospice 24/7 at 855-278-2764 for a complimentary consultation.