Nutritional Support for Dying or Severely Demented Patients

Anorexia Anorexia Physical, psychologic, emotional, and spiritual distress is common among patients living with fatal illness, and patients commonly fear protracted and unrelieved suffering. Health care providers... read more or loss of appetite is common among dying patients The Dying Patient Dying patients can have needs that differ from those of other patients. So that their needs can be met, dying patients must first be identified. Before death, patients tend to follow 1 of 3... read more .

Measures that may increase oral intake include

Certain antidepressants, megestrol acetate, and dronabinol may stimulate appetite. Metoclopramide enhances gastric emptying, but it may take 1 to 2 weeks to reach peak effectiveness.

Advanced dementia Dementia Dementia is chronic, global, usually irreversible deterioration of cognition. Diagnosis is clinical; laboratory and imaging tests are usually used to identify treatable causes. Treatment is... read more eventually leads to inability to eat; sometimes affected patients are given tube feedings. However, there is no convincing evidence that tube feedings prolong life, provide comfort, improve function, or prevent complications (eg, aspiration, pressure ulcers).

Tube feedings and parenteral nutrition cause discomfort and are usually not indicated for patients who are dying or too demented to eat. Forgoing nutritional support may be difficult for family members to accept, but they should understand that patients are usually more comfortable eating and drinking as they choose. Sips of water and easy-to-swallow foods may be useful. Supportive care, including good oral hygiene (eg, brushing the teeth, moistening the oral cavity with swabs and ice chips as needed, applying lip salve), can physically and psychologically comfort the patients and the family members who provide the care. Patients should be encouraged to enter a hospice program Hospice Dying patients can have needs that differ from those of other patients. So that their needs can be met, dying patients must first be identified. Before death, patients tend to follow 1 of 3... read more , which can provide the needed support.

Counseling may help family members who are dealing with anxieties about whether to use invasive nutritional support (see Total Parenteral Nutrition Total Parenteral Nutrition (TPN) Parenteral nutrition is by definition given IV. Partial parenteral nutrition supplies only part of daily nutritional requirements, supplementing oral intake. Many hospitalized patients are given... read more and Enteral Tube Nutrition Enteral Tube Nutrition Enteral tube nutrition is indicated for patients who have a functioning gastrointestinal (GI) tract but cannot ingest enough nutrients orally because they are unable or unwilling to take oral... read more ). Palliative care physicians are specifically trained to comfort patients and family members; early consultation with a palliative care team is encouraged.