Watching a loved one weaken due to a serious illness is incredibly difficult. This becomes even more challenging when families and caregivers notice that their hospice patient is eating and drinking less, or stopping altogether, as they approach the end of life. It’s natural to have many questions and concerns during this sensitive time.
Families often worry about several critical aspects when a hospice patient stops eating and drinking: Are we abandoning our loved one if we don’t try to feed them? What are the chances of survival without food and water in hospice care, and how long can a hospice patient realistically live without these necessities? Our traditions often center around food and drink as expressions of love and care. Are we withholding love if we stop providing nutrition and hydration? Are we, in effect, allowing our loved one to starve? Furthermore, will the absence of food and water cause pain or discomfort for our loved one in their final days? And most importantly, what can we do to ensure our loved one remains comfortable and free from suffering during this period?
There are crucial reasons why hospice care often shifts away from providing food and water in the final stages of life. Continuing to offer food and water, or resorting to artificial nutrition and hydration (ANH) methods like feeding tubes or IV fluids, can actually complicate the dying process and introduce new health problems.
For patients nearing the end of life, artificial feeding methods can lead to distressing complications. These can include gagging, discomfort, tube-related issues such as blockages or infections, aspiration pneumonia (when food or liquid enters the lungs), pressure sores, bloating, and even a sensation of drowning or feeling trapped. Moreover, research indicates that artificial nutrition provides minimal, if any, benefit in extending the life of hospice patients. Studies have demonstrated, for instance, that dementia patients who are fed through tubes do not have a longer life expectancy compared to those who are carefully hand-fed.
While hospice care won’t be denied to patients who already have feeding tubes in place, the hospice team will collaborate closely with the patient’s family and caregivers to determine whether continuing tube feeding is the most appropriate course of action. Although feeding tubes can technically be removed, the decision is often made to simply discontinue their use. Typically, feeding tubes are not inserted in patients who are terminally ill. Instead, the focus shifts to ensuring comfort and effective pain management as the end of life approaches. In rare instances, the hospice team might temporarily administer IV fluids to alleviate dehydration or enhance comfort, but oral intake of food and drink remains the primary and preferred method whenever possible.
The nutritional needs of a dying patient are significantly different from those of a healthy individual. As life nears its end, the body’s ability to effectively digest and process food and liquids gradually diminishes. As organ function declines and bodily systems begin to shut down, the requirement for nutrition and hydration becomes minimal, and in some cases, non-existent. It’s generally recommended to use the body’s natural and gradual decline as a guide for when to reduce or stop providing food and water to hospice patients.
Hospice care is highly personalized. VITAS Healthcare, like many hospice providers, emphasizes creating individualized care plans in partnership with patients and their families. These plans are designed to respect the patient’s wishes and values and always include thorough discussions about the role, or lack thereof, of artificial nutrition and hydration in end-of-life care.
Considering the numerous individual factors at play, it’s natural to wonder about the timeframe a hospice patient can live without food. Following the cessation of eating, a patient’s life expectancy can be as short as a few days. For the majority of individuals, this period without food typically lasts around 10 days. However, in some less frequent situations, it can extend to several weeks.
Patient choice is paramount when making decisions about nutrition and hydration at the end of life. Patients who prioritize quality of life in their final days often prefer to avoid being encumbered by tubes and medical equipment. This allows them to maintain physical closeness with their family and fully receive the comfort and care they desire during this precious time.
Family members and caregivers are integral in providing support to their loved one throughout the dying process. If the patient is still able to eat or drink, offer small sips of water or other liquids, ice chips, hard candies, or very small spoonfuls of soft food. Always pay close attention to the patient’s cues to know when to stop. If the patient can no longer drink, focus on keeping their lips and mouth moist using swabs, a damp washcloth, lip balm, or moisturizers. If the patient can no longer eat or is refusing food, remember to offer alternative forms of nourishment. This can include engaging in conversation, providing loving touch, playing music, singing, reading poetry, sharing humor, arranging pet visits, giving gentle massages, reading aloud, praying together, or simply offering other acts of caring and love.
Ideally, decisions about end-of-life care should be made proactively, while everyone is in good health and able to clearly express their wishes. This is the optimal time to create and share an advance directive with family members and healthcare professionals. However, in reality, these critical decisions are often postponed until the patient is no longer able to communicate their preferences. In such cases, family members, in collaboration with a knowledgeable healthcare team, must make these important choices. Hospice professionals are equipped to offer specialized care and support regarding nutrition and hydration as death approaches. The hospice team will continue to focus on pain relief and symptom management. They will also respect the family’s personal, cultural, and religious beliefs and values concerning nutrition and hydration. Family members and caregivers will receive guidance on how to compassionately manage thirst and hunger in a patient’s final days without resorting to artificial means. In the final weeks, days, and hours of life, families will be reassured that the patient’s declining health and eventual death are a result of the underlying disease progression, and not due to the natural decrease and eventual cessation of eating and drinking.
