When a Hospice Patient Stops Eating or Drinking

Our minds connect food with life. The sharing of meals with family and friends holds tremendous emotional, social and cultural significance. Food and drink are a large part of life’s celebrations and food is often used as a way to share comfort with the ones we love. Perhaps this is why it is often so upsetting when a critically ill patient loses interest in eating and drinking.

However, changes in the ability and desire to eat are a natural consequence of terminal illness, usually beginning as a mild distaste for certain foods, progressing to a desire for only select foods, and often resulting in a complete lack of desire to eat. 

In addition, in cancer patients, the body releases chemicals that affect taste buds as well as parts of the brain that control taste, nausea, vomiting and the sense of fullness. Chemotherapy, radiation therapy and some medications may also cause decreased appetite. Certainly, the patient’s feelings of sadness or depression may play a part, but the problem is also directly related to the cancer. 

Why does this loss of appetite upset us?

When a terminally ill patient does not eat, not only is the opportunity lost for a comforting shared activity, but fears about a loved one’s survival can surface. Family members often work hard to find and prepare foods that might be appealing, only to have the person take a few bites and report feeling full or that the food tastes bad.

Family members may feel frustrated, helpless and afraid of what will happen if a terminally ill patient doesn’t eat. But it’s important to remember that at this point the body’s need for nutrition is minimal and terminally ill patients have told us dehydration is not painful. Since the mouth does get dry, this dryness may be relieved by giving the patient ice chips, artificial saliva or moisturizers for the lips.

When patients express a lack of desire to eat, they often wish family members would not push them. They sense the frustration of the family and may feel pressured to eat, even though it might cause them discomfort. It’s also important to note that prolonged use of intravenous fluids, tube feedings, and other means of delivering artificial nutrition are usually not effective for people in the advanced stages of a terminal illness.

For both patient and family, this loss of appetite can be one of the most distressing parts of an illness.

What can you do?

• Accept the loss of appetite as an expected and normal part of the terminal illness. 
• Allow the patient to select food and drinks. Offer different choices, but don’t push! 
• Find other ways of showing love and concern such as giving a foot massage or playing a game.   
• Talk with other loved ones instead of the patient to help lessen your frustration when the patient is unwilling to eat.  

What can you do at mealtimes? 

Remember, for the person with a terminal illness the desire for food and the body’s need for food are minimal. The most important thing is for the patient to enjoy whatever food or drink is taken. 

• Offer medication for nausea thirty minutes to an hour before eating.
• Anti-nausea medication may be given in a suppository form and administered rectally if a patient is unable to tolerate oral medication.
• Avoid using straws, which may increase the swallowing of air, leading to burping or nausea.
• Serve food in a pleasant environment, preferably at the table if the patient is comfortable sitting.
• Serve the patient frequent, small meals.
• Serve small amounts of food in small containers, maybe even one item at a time.
• Serve liquid breakfast drinks, canned supplements or homemade high-calorie shakes.
• Add dried milk or dried protein powder to liquid or soft foods to add calories.
• Serve fruit juices such as prune or apricot nectars to provide additional calories.
• Give liquids in other forms, such as Jell-O, pudding, popsicles and ice cream.

Family members play an important role by supporting a loved one through the dying process. When a patient no longer eats, providing other forms of nourishment — such as conversation, loving touch, music, singing, poetry, humor, pet visits, gentle massage, reading or prayers — can also show how much you love and care.

INTEGRIS Hospice House offers in-patient hospice care and short-term respite care to provide relief for caregivers. For more information on INTEGRIS Hospice House of Oklahoma City, call 405-848-8884.