Witnessing a loved one decline due to a serious illness is incredibly painful. This becomes even more difficult when you notice a hospice patient, someone you deeply care for, stops eating and drinking as they approach the end of their life.
It’s important to understand that a person nearing the end of life has very different nutritional needs compared to someone who is healthy and active.
Families naturally have many questions and concerns during this time:
- Are we abandoning our loved one if we don’t try to feed them or offer fluids?
- What are the chances of survival for someone in hospice who isn’t eating or drinking? How long can a hospice patient live without food and water?
- Food and drink are often symbols of love and care in our families. Are we withholding love if we stop providing nutrition and hydration? Are we letting our loved one starve?
- Will refusing food and water cause pain or suffering for our loved one at the end of life?
- What can we do to ensure our loved one is comfortable and not in pain?
Why Hospice Care Often Reduces Food and Water at the End of Life
Continuing to push food and water, or choosing artificial nutrition and hydration (ANH) methods – such as feeding tubes inserted through the nose (NG) or stomach (PEG), or IV fluids for hydration – can actually complicate the dying process and lead to further health issues.
For end-of-life patients, artificial feeding can cause distressing complications like gagging, discomfort, tube problems (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.”
Furthermore, research indicates that artificial nutrition provides minimal benefit for hospice patients in terms of survival. For instance, studies have shown that dementia patients who are fed through tubes have similar life expectancies to those who are carefully hand-fed.
The Realities of Feeding Tubes in Hospice
Hospice care will not be denied to a patient who already has a feeding tube in place. The hospice team will work closely with the patient, their family, and caregivers to determine whether continuing to use the tube is appropriate. While it is technically possible to remove a feeding tube, the decision is often made to simply discontinue its use.
Generally, feeding tubes are not placed in patients who are terminally ill. Instead, all efforts are focused on ensuring comfort and pain management as the end of life approaches. In limited situations, the hospice team might temporarily administer IV fluids to alleviate dehydration or enhance comfort, but feeding and drinking are primarily encouraged by mouth, if possible and desired by the patient.
Determining When to Stop Feeding a Hospice Patient
The nutritional needs of a person dying are significantly different from those of a healthy individual. As life nears its end, the body gradually loses its capacity to digest and process food and liquids. As organs and bodily functions naturally slow down, the need for nutrition and hydration diminishes, sometimes becoming negligible. It’s often recommended to observe the body’s natural decline as a guide to when to stop providing food and water to hospice patients.
VITAS Healthcare, and similar hospice providers, prioritize creating personalized care plans in collaboration with patients and families. These plans respect the patient’s wishes and values, and they include open discussions about the role, or lack thereof, of artificial nutrition and hydration at the end of life.
Understanding the Timeline: How Long Can Hospice Patients Live Without Eating?
Considering the numerous individual factors at play, it’s natural to wonder: how long can someone live without food in hospice care? Once a patient stops eating, death can occur in as little as a few days. For most individuals, this period without food typically lasts around 10 days, but in some cases, it may extend to several weeks.
Providing Support: How Family Members and Caregivers Can Help
Patient choice is the most crucial factor in decisions about nutrition and hydration at the end of life. Patients who prioritize quality of life in their final days often prefer to be free from tubes and medical equipment, allowing for closer physical connection with family and the comfort care they desire.
Family members and caregivers are vital in supporting a loved one through the dying process in ways beyond food:
- 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. Pay close attention to the patient’s cues to know when to stop.
- If the patient can no longer drink, keep their lips and mouth moist using swabs, a damp cloth, lip balm, or moisturizers.
- If the patient can no longer eat or refuses food, provide nourishment in other meaningful ways: through conversation, gentle touch, music, singing, poetry, humor, visits from pets, gentle massage, reading aloud, prayers, or simply being present and showing love and care.
Creating a Compassionate End-of-Life Care Plan
Ideally, decisions about end-of-life care are made when everyone is healthy and able to communicate clearly. This is the right time to create and share an advance directive with family and healthcare professionals.
However, often these important decisions are postponed until the patient is no longer able to express their wishes. In these situations, family members and the healthcare team must make these choices together. Hospice professionals can 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.
- The family’s personal, cultural, and religious beliefs and values concerning nutrition and hydration will be respected.
- Family members and caregivers will receive guidance on how to compassionately manage thirst and hunger without resorting to artificial methods in the patient’s final days.
- In the final weeks, days, and hours of life, families will be reassured that the patient’s decline and eventual death is a result of the underlying disease progression, and not due to the natural decrease and eventual cessation of eating and drinking.
