Watching a loved one decline due to a serious illness is incredibly difficult. This becomes even more challenging when, especially in hospice care, family members and caregivers observe a patient ceasing to eat and drink. It’s natural to have many questions and concerns during this time, particularly surrounding the patient’s basic needs and comfort.
Families often grapple with questions such as:
- Does withholding food and water mean we are abandoning our loved one?
- What is the prognosis when a hospice patient stops eating and drinking? Specifically, how long can a hospice patient realistically survive without food and water?
- Our family traditions center around food as an expression of care and love. Are we depriving our loved one of love by not providing nutrition and hydration? Are we causing them to starve?
- Will the absence of food and water cause pain or suffering for our loved one as they approach the end of life?
- What steps can we take to ensure our loved one remains comfortable and free from suffering during this phase?
It’s important to understand that the nutritional needs of a person nearing the end of life are significantly different from those of a healthy, active individual.
Why Reduced Food and Water Intake is Common in End-of-Life Care
Continuing to push food and fluids, or even resorting to artificial nutrition and hydration (ANH) methods like feeding tubes (nasogastric or PEG tubes) or IV fluids, can paradoxically create more problems and discomfort for individuals in hospice care.
Artificial feeding at the end of life can lead to distressing complications. Patients may experience gagging, discomfort, tube-related issues such as blockages or infections, aspiration pneumonia (where food or liquid enters the lungs), pressure sores from immobility, bloating, and a distressing sensation of drowning or feeling trapped.
Furthermore, research indicates that artificial nutrition provides minimal, if any, benefit in extending the lifespan of hospice patients. For instance, studies have shown that dementia patients receiving tube feeding do not have a statistically different life expectancy compared to those who are carefully hand-fed. This highlights that the perceived benefits of artificial feeding may not outweigh the burdens they impose at the end of life.
Feeding Tubes: Considerations in Hospice
Hospice care will not be denied to patients who already have a feeding tube in place. The hospice team will collaborate closely with the patient, their family, and caregivers to determine the most appropriate course of action regarding the feeding tube. While removal is technically possible, often the decision is made to simply discontinue its use, focusing instead on comfort and quality of life.
Generally, feeding tubes are not initiated for patients who are terminally ill and entering hospice care. The primary focus shifts to ensuring comfort and effective pain management as the end of life approaches. In specific, uncommon situations, the hospice team might administer IV fluids temporarily to alleviate dehydration or enhance comfort, but oral intake remains the preferred and primary method of eating and drinking when possible and desired by the patient.
Determining When to Reduce or Stop Feeding in Hospice
The nutritional requirements of a dying patient differ significantly from those of a healthy person. As the body naturally begins to shut down in the final stages of life, its ability to digest and process food and liquids gradually diminishes. Organ function declines, and the need for substantial nutrition and hydration decreases, often becoming minimal or even non-existent. Observing the body’s natural decline serves as a compassionate guide in determining when to reduce or stop providing food and water to hospice patients.
Hospice care emphasizes individualized care plans. VITAS Healthcare, and hospice providers in general, prioritize working with patients and their families to create personalized care plans that reflect the patient’s wishes, values, and priorities. These crucial plans include open and honest discussions about the role, or lack thereof, of artificial nutrition and hydration in their specific situation.
How Long Can Someone Survive Without Food and Water in Hospice?
Given the numerous individual factors at play, it’s understandable to wonder about the duration of survival without food and water in hospice care. When a patient stops eating and drinking, death can occur relatively quickly, sometimes within just a few days. For the majority of individuals, the period without food typically lasts around ten days. However, in some instances, although less common, this period can extend to several weeks.
It’s important to remember that the cessation of eating and drinking is usually a natural part of the dying process and not the direct cause of death. The underlying terminal illness is the primary driver of the body’s decline.
Providing Comfort and Care Beyond Food
Patient autonomy and quality of life are paramount in end-of-life care. Many patients prioritize comfort and meaningful interactions with loved ones in their final days, often preferring to be free from medical equipment like tubes. This allows for greater physical closeness with family and facilitates the comfort care they desire.
Family members and caregivers are integral to supporting their loved one through this delicate phase:
- If the patient is still able to eat or drink: Offer small sips of water or other liquids, ice chips to moisten the mouth, hard candies for minimal oral stimulation, or very small spoonfuls of soft food if desired. Always be guided by the patient’s cues and stop when they indicate they’ve had enough or no longer want to continue.
- If the patient can no longer drink: Focus on keeping their lips and mouth moist and comfortable. Use oral swabs, a damp washcloth, lip balm, or moisturizers to prevent dryness and cracking.
- If the patient can no longer eat or refuses food: Shift the focus to alternative forms of nourishment that provide comfort and emotional support. Engage in meaningful conversations, offer loving touch, play soothing music, sing favorite songs, share poetry or humorous stories, arrange pet visits if the patient enjoys them, provide gentle massage, read aloud, offer prayers if appropriate, or simply be present and offer loving care in other personalized ways.
Crafting a Compassionate End-of-Life Plan
Ideally, important decisions about end-of-life care, including nutrition and hydration, should be made proactively when everyone is healthy and able to communicate their wishes clearly. This is the optimal time to create an advance directive, such as a living will, and share it with family members and healthcare professionals. This proactive approach ensures the patient’s voice is heard and respected.
However, in reality, these crucial conversations are often postponed until the patient is no longer able to express their preferences. In such situations, family members, in collaboration with a knowledgeable hospice care team, must make informed decisions that align with the patient’s likely wishes and best interests. Hospice professionals offer specialized expertise and support regarding nutrition and hydration as death approaches.
Hospice care provides comprehensive support:
- The hospice team will prioritize continuous pain relief and effective symptom management to ensure the patient’s comfort.
- The patient’s and family’s personal, cultural, and religious beliefs and values surrounding nutrition and hydration will be fully respected and honored in all care decisions.
- Family members and caregivers will receive education and practical guidance on how to compassionately manage thirst and hunger without resorting to artificial means during the patient’s final days.
- Throughout the final weeks, days, and hours of life, families will receive reassurance and understanding that the patient’s progressive decline and eventual death are a direct result of the underlying disease process, and not due to the natural decrease and eventual cessation of eating and drinking. This helps alleviate guilt and anxiety surrounding food and fluid intake at the end of life.
