Welcome to House of Light, a blog produced and managed by the staff of Casa de la Luz Hospice. Casa de la Luz ("house of light" in Spanish) is a locally owned and operated hospice, serving the city and surrounding communities of Tucson, Arizona. Through this blog, we hope to offer education, information, and support about caregiving and hospice care to terminally ill patients and their loved ones. For more information, visit the contact us page.

Monday, August 15, 2011

Nutrition and Hydration at End of Life

“You mean you’re not going to make him eat.”

That’s a statement that is sometimes said by grieving people when their friend or family member is dying. One of the most difficult decisions that must be made at end of life is whether or not to insist someone eat or drink, or to use artificial nutrition and hydration.

Sometimes family members fear that they are “starving” their loved one. When someone is not well, our first response is to make sure they are provided with fluids and food in order for them to get better. That is what we have always known, and that is how we operate. When someone is sick, we bring them chicken soup. In reality, when we have the flu, we often don’t feel hungry or thirsty, and we may force ourselves to eat or drink so we can improve.

During the end of life process, there is not anything that can help someone get better. Instead, the organs start to shut down. When that occurs, our loved one usually doesn’t feel hungry or thirsty. Their mouth may get dry and that can be uncomfortable. At this point, water on a sponge is provided frequently as part of mouth care. It is best to offer water, ice chips, and other fluids as long as someone wants them and is able to tolerate them.

When our loved one refuses food or water, or they are no longer responding to us, nutrition and hydration at this point can create many discomforts and complications instead of helping them “feel better.” If the person is not able to swallow, they can choke on or “aspirate” the liquid or food into their lungs. This can be excruciating and can lead to pneumonia. Also, if the person’s organs are not working properly, fluids and foods can lead to nausea and vomiting. Food cannot be digested in the same way a healthy body digests food.

An unfortunate result of IV fluids is often swelling, or “edema,” because the kidneys are not able to properly utilize the fluids, and they pool into areas of the body such as the hands, feet, and the lungs. Swollen extremities can be very painful, and fluids entering the lungs can contribute to pneumonia. In other words, our best intentions of making our loved one “better” or “more comfortable” can often do exactly the opposite of what we want.

If someone can and desires to eat or drink, then encourage them and give them anything that sounds good. We had a patient once who had bites of ice cream every couple of hours. Why not? But even if your loved one is not desiring food or drink, rest assured that when you do not force someone to eat or drink, you are actually helping them to be “more comfortable” during the dying process.

By Kim Bingham, Social Worker

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