Hunger and Thirst
By: Marygrace Lomboy, CRNP… The sudden or gradual loss of appetite is extremely difficult for the dying person’s loved ones to witness. Many caregivers will wonder if their loved one is “getting enough” nutrition as appetite starts to decline. This was a vivid struggle for my own family. What made it even harder is that my mother is a marvelous Italian cook – we centered our life celebrations on food. All of our family get togethers were focused around the food, and lots of it. My mom often equated food with health, and feeding my Dad was truly an act of love that got more and more difficult as time went on. My dad would often just take a few bites and push the plate away. By watching my Dad refuse my mom’s delicious food made his health decline a reality for my family and myself. At times, we felt completely helpless.
As a caregiver, you may be concerned about food and fluid intake of your loved one. As disease progresses, you may also question if they should be receiving intravenous fluids or tube feedings. It often comes up if your loved one is going to “starve” to death or become severely dehydrated. Providing something as basic as food and fluids is fundamental to the role of caregiver. No caregiver wants to cause additional suffering if their loved one is hungry or thirsty.
As difficult as it is, it’s important to understand that loss of appetite and weight loss is a normal part of the functional decline and the natural dying process. Appetite loss may be gradual or quite sudden, but nearly all patients at end of life stop eating and drinking at some point. Often it will manifest as increased difficulty in swallowing, other times, it is just a complete loss of appetite and interest in food and/or refusing food completely.
However difficult this process may be, the lack of eating and drinking causes more distress for families than their loved one who is declining. Continue to offer soft comfort foods and sips of water or drink of choice as long as your loved one is conscious and able to swallow. Prior to offering foods or fluids, make sure your loved one is upright to avoid aspiration. Try to be as accepting as you can if they refuse food or fluids.
As time goes on, your loved one may exhibit signs of dry mouth and/or thirst. There are many studies in the literature that have been done regarding thirst and IV hydration at the end of life. Studies have shown IV hydration isn’t effective in alleviating thirst much, if at all. The most important point in caring for your loved one at end of life is good oral hygiene. Oral swabs dipped in diluted mouthwash and lubricants are usually adequate to relieve dry mouth. Use lubricant on your loved ones lips with either lip balm or a small amount of Vaseline to keep them from drying out and cracking.
If you are faced with making a difficult decision to withhold or withdraw feedings and/or hydration; make sure to consult with your loved one’s doctor about the benefits and risks as it pertains to your individual case.