End-of-life nutrition is a much debated subject these days, partly because there is a general misconception about the nutritional needs of elderly persons who are in the final stages of life. This is understandable, since the intuitive assumption most people have is that food and water are necessary for all individuals right up until the time of their passing.
In truth, this is not altogether accurate, especially for individuals in an advanced state of illness who may be suffering from dementia, or are in a permanent vegetative state. In fact, for elderly persons in these final stages, it has been demonstrated that forcing nutrition upon them via intravenous tubes or other methods, can actually have very negative effects. Terminally ill patients who receive unneeded nutrition often suffer from increased nausea and vomiting, incontinence, infections, edema, or bleeding.
The debate about whether to continue providing nutrition and hydration to a terminally ill patient will probably continue for some time, because it is a very difficult decision for loved ones to address, and because the benefits or drawbacks of providing nutrition are not always crystal-clear. However, there are several ways that hospice care providers can help provide nutritional needs for terminally ill patients before they reach that final phase of life, in perhaps the last three weeks or so.
#1 – Make mealtimes enjoyable
One of the things hospice care providers are very much in tune with is detecting signs from their elderly patients regarding interest in eating or drinking. Since most hospice care patients experience diminishing appetite throughout the day, breakfast should be the meal which gets the most attention. This is a good time to provide a patient’s favorite foods in small amounts, possibly including nutritional supplements along with other breakfast foods. The care provider will know when it’s not advisable to push food on a patient, and how much more appropriate it is to allow them to make the choice. Breakfast and other meals can also be made as pleasant as possible by providing soft, comforting music, and maybe even some cheery flowers.
#2 – Help with housekeeping tasks
Even while hospice patients are still in the early stages of illness, they may still require help with some of the basic requirements of day-to-day life, such as dressing, bathing, and navigating around the facility. This kind of care can be provided by the hospice caregiver at whatever level is needed by the elderly patient, because in most cases, they are unable to perform some or all of these tasks. Personal hygiene is still important, so all such activities as brushing teeth, washing hair, cutting fingernails/toenails, and either showering or bathing regularly are still necessary.
#3 – Recognizing when eating/drinking is advisable
There can be a fine line between stubbornness and refusing to eat or drink because the dying process has begun. Hospice caregivers understand that an elderly patient in the final stages of life is not being stubborn by refusing food or drink, but is more likely to be in touch with their own body signals. It is not stubbornness or suicide for an elderly hospice patient to refuse food, because they are past the point where nutrition and hydration can restore health.
Recognizing this stage of the process, a hospice caregiver realizes that nothing should be forced upon the patient, and that their wishes should be respected in the matter. An experienced caregiver knows when this point has been reached, and until then, can suggest modest amounts of food and water.
#4 – Caring for ‘dry mouth’
Dry mouth is a very common development in hospice patients, because dehydration is beginning to take hold of the body, and there is simply less fluid available. The solution to this is not to force water on the hospice patient, as hospice caregivers are well aware, but to provide assistance with managing the dry mouth condition. At this state, dehydration is not an indication that the body needs fluid, it is more an indication that the body is beginning to shut down, and is a very natural part of the dying process.
It’s very easy to recognize dry mouth by its associated symptoms: lips which are dry, and either chapped or cracked, along with an obvious difficulty with swallowing. These uncomfortable symptoms can be alleviated by providing the hospice patient with cold, moist foods like ice cream or popsicles. The elderly person can also be discouraged from licking the lips, since that will likely worsen the problem, but vaseline or lip balm can be applied to help dried lips.
#5 – Providing informed input to family physician
During the final stages of life, hospice patients will eventually reach the point where even intravenous feeding has little value, and will actually be counter-productive for the patient. The hospice caregiver who has been in company with the patient for those final weeks can provide very important observations about alertness, symptoms of illness, interest in food, activity levels, and many other aspects of the living and dying process. All these will help the physician and family members consult and evaluate the specific situation and stage of life that an elderly person might be at. These decisions are always difficult ones, so the information provided by a caregiver can be very significant.