Eventually, people who are dying lose their appetite Loss of appetite Many fatal illnesses cause similar symptoms, including pain, shortness of breath, digestive problems, incontinence, skin breakdown, and fatigue. Depression and anxiety, confusion and unconsciousness... read more , and people with advanced dementia Dementia Dementia is a slow, progressive decline in mental function including memory, thinking, judgment, and the ability to learn. Typically, symptoms include memory loss, problems using language and... read more become unable to eat. Family members are often concerned about providing nutrition for these people and may consult a doctor about using tube feeding Tube Feeding Tube feeding may be used to feed people whose digestive tract is functioning normally but who cannot eat enough to meet their nutritional needs. Such people include those with the following... read more or intravenous feeding Intravenous Feeding Intravenous feeding is used when the digestive tract cannot adequately absorb nutrients, as occurs in severe malabsorption disorders. It is also used when the digestive tract must be temporarily... read more 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.
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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 (see Advance Directives Advance Directives Health care advance directives are legal documents that communicate a person’s wishes about health care decisions in the event the person becomes incapable of making health care decisions. There... read more ).
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 30 minutes 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. Hospice care Hospice Care Hospice is a concept and a program of care that is specifically designed to minimize suffering for dying people and their family members. In the United States, hospice is the only widely available... read more personnel can provide the needed support.
Counseling may help family members who are worried about whether to use nutritional support.
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