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Nutritional Support for People Who Are Dying or Severely Demented

by David R. Thomas, MD

Eventually, people who are dying lose their appetite (see Loss of appetite), and people with advanced dementia become unable to eat. Family members are often concerned about providing nutrition for these people and may consult a doctor about using tube or intravenous feeding methods (nutritional support). Family members are inclined to want to use nutritional support for many reasons. For example, food has been associated with love, caring, hospitality, and support in all cultures throughout history. Also, family meals may be a social activity that family members are reluctant to give up.

However, nutritional support appears to have no benefit. It does not appear to prolong life or improve the quality of life. Many doctors and nurses who care for dying people believe that the days before death may be made more uncomfortable if people are given nutritional support or made to eat more than they want. People who have advanced dementia or who are dying are not distressed by feeling hungry. They are usually more comfortable when they eat and drink as they choose. During the dying process, the body starts to shut down, and a person may lose the desire for food and drink. Also, until recently in human history, dying people were not given nutritional support nor forced to eat more than they wanted to. So doctors usually do not recommend nutritional support.

Did You Know...

  • People who are dying or who have advanced dementia should not be forced or urged to eat more than they want.

If death is not expected to occur within hours or days, nutritional support may be tried for a limited time to see whether the person's comfort, mental clarity, or energy improves. Often, improvement does not occur. The dying person and family members should have an explicit agreement with the doctor about when to try and when to stop nutritional support, especially when it is not helping.

Nonetheless, family members and caregivers can offer food in ways that are comforting and that gently encourage the person to eat:

  • Provide food slowly.

  • Offer small portions of food and small sips of water.

  • Offer favorite, strongly flavored, or easy-to-swallow foods.

  • Offer a small amount of a favorite alcoholic drink, given before meals.

  • Most of all, allow the person to choose when and what to eat and drink.

Appetite stimulants, such as certain antidepressants, megestrol, or dronabinol, may help.

Providing other care, such as brushing the person's teeth, moistening the person's mouth with wet swabs as needed, giving the person ice chips, and applying lip salve, can physically and psychologically comfort the dying person and the family members who provide the care.

Counseling may help family members who are worried about whether to use nutritional support.

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