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Nutritional needs at the end of life
Sharing food is one way we nurture
and care for those we love. When a seriously ill family member
doesn’t eat, it can be very distressing. Depending on
the disease, however, refusing food can be a very normal part
of the process. Sometimes forcing someone to eat can make things
worse. If the person you care for is near the end of life,
his or her body does not have enough strength to handle digestion,
breathing, thinking, and fighting the disease all at once.
Under some circumstances, eating, digesting, and eliminating
food can be painful or cause distressing symptoms such as vomiting,
diarrhea, and bloating. Even the simple intake of fluids can
make it difficult to breathe because of a buildup of secretions
in the lungs. As contrary as it might seem, at the very end
of life food and fluids may cause more distress than going
without. (Return to list)
Special diets and serious illness
Seniors frequently have chronic
conditions such as diabetes or heart disease that are known
to respond well to specialized diets. Certainly if an elder is healthy and active,
it is wise to stick to these regimens as much as possible. But in the case of
life threatening illness, there are other factors to consider.
The American
Dietetic Association has written a position paper
supporting liberalized diets for the elderly. Although the
context is for nursing homes, the principles apply for any
frail, older adult. They state that quality of life can
be just as important to the frail elderly person as is nutrition.
Eating is not just a biological process. Food has many social,
cultural, and psychological meanings as well, and these
factors have a strong influence on our enjoyment of life.
As for daily living, dieticians have determined that a restrictive
diet for frail elders may not be all that helpful. If medicines
can compensate for a change in eating habits, dieticians now
encourage the seriously ill to add "comfort foods"
to their diets. The goal of healthy eating is to affect overall
health. If restrictive diets—for instance, lack of salt—are
altering a frail patient’s ability to enjoy life, then
the dietary regimen is not meeting its goal of overall health
and well being.
The take-home message? What individuals with life
threatening illness eat is generally not as important as how much they
enjoy the experience of eating. (Return
to list)
Refusing to eat
With terminal diseases such
as cancer, it is natural to lose one’s appetite. In fact,
feeding a patient artificially (through a tube, for example)
has been shown to help a tumor grow even faster! Not eating
may be one of the body’s natural defense mechanisms.
Forcing food is not likely to help dying patients "keep
up their strength." Near the end of life the effort
required to eat, digest, and eliminate simply becomes too
much to handle. Loss of appetite is a natural part of the
dying process. You will be doing the person you care for
a favor to honor his or her wishes regarding food.
There is some controversy about
the rights of a person to refuse to eat or take in fluids
just as there is controversy about the rights of an individual
to refuse medical treatment. If an individual near the end
of life chooses not to eat or not to drink water and nature is allowed to take
its course, that person will probably die within 10 to 14 days. If he or she
continues to take in fluids, the dying process may be prolonged by several weeks.
Refusing food or water during terminal illness
is not like starvation. It does not cause a painful death. Quite the contrary;
after a day with no food or water, the body produces a natural painkiller. The
patient loses any sensation of hunger or thirst and even seems to experience
slight euphoria. Lack of fluids may also help the patient be more comfortable
because it reduces symptoms such as nausea, vomiting, bloating, and diarrhea.
It can also help decrease the amount of fluid buildup in the lungs, which can
reduce the need for bothersome suctioning procedures. The only discomfort identified
is a parched or dry mouth that often happens with dehydration. Lip balm for
the lips and ice chips or a mouth swab dipped in water can
do much to relieve the symptoms of dry mouth. (Return
to list)
Choosing to start or discontinue
artificial feeding
If a patient is no longer able
to communicate preferences, the decision to start or stop
artificial feeding may be one of the more difficult decisions
a family has to make. In the absence of an advanced directive,
you must follow your own wisdom and your own understanding
of your loved one’s desires regarding quality
of life. As mentioned in the previous paragraphs,
losing the desire to eat is a natural part of the dying process.
Forcing food and fluids on the patient can in fact cause more
discomfort in his or her final days.
It can be disconcerting to decide to withhold food or fluids.
Despite evidence that this choice may well be the most merciful
one, many people find it difficult to think that they may
be starving their loved one to death. Each family must come
to terms with its own understanding of its loved one’s
wishes and its own version of compassion. Whatever you decide,
it is important to remember that artificial feeding may postpone
the moment of death by days or weeks, but it will not keep
a terminally ill person from dying. (Return
to list)
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