When a Hospice Patient Stops Eating or Drinking: What to Expect

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Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

When someone is receiving hospice care, they are expected to die. Hospice care is about end-of-life care that treats the patient with dignity, respect, and concern for their comfort. As the family member of someone who is dying, there are overwhelming emotions of impending loss and the grief associated with knowing you will lose a loved one. 

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There are specific biological processes that occur when someone is dying, but there is also much that we don’t know. Watching someone die is not comfortable because they are often suffering and in pain. When a hospice patient stops eating or drinking, it can be alarming. 

Even though you may know and expect someone to stop eating and drinking, you also know that eating and drinking are required for sustaining life. From birth to adulthood, we focus much of our time, social interactions, and pleasure on eating. Therefore, to deny someone food and drink seems cruel and heartless. However, there comes a time at the end of life when stopping eating and drinking is natural.

Why Do Our Loved Ones in Hospice Stop Eating or Drinking? 

Stopping eating and drinking when someone is on hospice is natural. Your loved one may go through periods of time when they stop, then start again. The body is shutting down, which can take what seems like an excruciating amount of time. Remember, the person is not dying because they stop eating and drinking, but life cannot continue without nutrition and hydration.

Lack of appetite

Lack of appetite when someone is dying is common and a contributor to a lack of interest in drinking or eating. Speculation is that the body produces more catecholamine, which is a chemical that suppresses the appetite. Also, the body doesn’t digest food as easily, leading to an upset stomach when eating.

The digestive system takes a lot of energy to use food and water, and a dying person may not have the ability to process food and water. As a result, food and water may become intolerable. 

Lack of energy

When someone is dying, they do not expend very much energy. Your loved one may rest most of the day, and towards the very end of life, they may not move from a lying position. Less energy means less calories to sustain life. This cycle of not eating and drinking leads to more fatigue and less energy, which is natural in the case of dying. 

Pain

If you think about a time you have been in pain, food is probably the last thing on your mind. Part of hospice care is pain relief which means administering pain medications. Typical pain medications include opioids, fentanyl, hydrocodone, morphine, methadone, percocet, and others. One of the most common side effects of opioid medications is nausea and sleepiness, all of which affect appetite and the desire to drink. 

Disease process

Many diseases have appetite and weight loss as a secondary symptom. Diseases such as cancer, congestive heart failure, and others may affect one’s appetite. Nausea, vomiting, lack of taste, constipation or diarrhea all have a depressant effect on appetite.

Lack of interest and psychological distress

The body has its unique dying process, and then there is the spiritual and psychological aspect of dying. Every individual is different, and the way they handle death is a complex interaction of spiritual, religious, social beliefs and closely held values. 

For some, unresolved family issues, ambiguity about what happens after death, and fear can create enormous psychological distress affecting appetite and drinking. Anxiety is a common reaction to the dying process if the person is not at peace. 

Some people are very much ready to die and accept the biological and psychological process and stop eating and drinking because they have no interest or desire. 

Swallowing issues

Individuals with Alzheimer’s disease and other neurological conditions have problems swallowing due to the disease process. Difficulty swallowing and all of the different processes discussed contribute to a decreasing appetite and thirst. Forcing someone to eat and drink under these circumstances can lead to choking.

Can You Do Anything After Your Loved One Stops Eating or Drinking? 

The question of what you can do after your loved one stops eating and drinking vexes many families. A good hospice company will walk you through the process, options, and consequences of decisions. Unfortunately, families often have internal conflicts about what is best for a dying person when that person loses their appetite. 

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Give the person whatever they want to eat and drink whenever they want it

This approach accepts that the person will die and that they have a right to eat whatever they want. If they were on a special diet that was low in sugar, for example, and they wanted chocolate pudding, give it to them. Pleasures are few and far between at this stage, and this line of thinking is consistent with providing as much comfort as possible.

Only provide and urge intake of nutritious foods

Some members of your family may have strong feelings about the value of urging nutritious food for your loved one. Differences of opinion on this matter cause many family conflicts. The desire for your loved one to eat may come from guilt and not wanting the person to die.

The consequences of this decision are that it may cause your loved one a great deal of stress when they don’t have many precious moments left. Also, urging someone to eat when they don’t want to can cause physiological distress such as nausea, diarrhea, or intestinal pain.

Feeding tubes and artificial hydration

One of the big misunderstandings about dying is that even with artificial nutrition and hydration, your loved one will still die. Artificial nutrition and hydration should only occur in tandem with advance directives. By deciding on a feeding tube, you are not necessarily making the person more comfortable, and neither are you prolonging their life. 

Moisten lips 

Drinking water at the end of life can be uncomfortable and can lead to a fluid build-up in the lungs. However, treat a dry mouth and lips by moistening with water from a spray bottle, washcloth, or dropper. If your loved one can tolerate it, you can place ice chips in the mouth. A dry mouth is susceptible to infection and becomes very sore and painful.

What Can You Expect After a Hospice Patient Stops Eating?

Knowing what to expect after a hospice patient stops eating can help keep you calm, which in turn helps your loved one. Although everyone is different, there is a biological process that occurs as someone approaches death. You may wonder how long someone can last without eating or drinking, and there is no set rule, and ten days is the norm, but some people can last longer. These are the things you can expect to happen.

Breathing changes

As the dying person’s body becomes less active, they require less oxygen. On occasion, the breath may sound like a rattle due to the inability to swallow liquids. Breathing may also become much slower and quieter.

Sleeping more

As energy decreases, the hospice patient may sleep more. Some of this may be due to pain medications, but your loved one may drift in and out of consciousness.  Remember that even though they are sleeping, they can probably still hear you.

Skin changes

When someone has stopped eating and drinking, their skin may feel cold to the touch and appear blue or mottled.

Restlessness

For some of the time, the person on hospice may become more agitated and restless. They may be confused, disoriented, and have hallucinations but then have lucid periods. Just before their death your loved one may become more peaceful. 

Loss of bladder and bowel control

When someone eats less, they may have fewer bowel movements and lose bladder and bowel control. This is normal, and keeping someone clean is part of hospice care.

Eyes

As someone is dying, they are less likely to open their eyes and may close their eyes most of the time. Their eyes may be half-closed much of the time.

Emotional changes

When someone is actively dying, it is hard to know what they are going through and what is important to them. If your loved one is agitated, try and calm the dying person, and let them know you are there for comfort.

It is not unusual for someone to have visions and hallucinations and see people from the past or say unexpected things. If you are waiting for other family members to arrive to say goodby let your loved one know that. They may be waiting to let go until everyone is there. 

If you have things to say that are important to you, say them. No one can predict when death will occur, so it is better to communicate your love and care while you can and while they can receive the messages. Death may come much sooner than expected, and you don’t want to have any regrets about things left unsaid. 

How to Manage When Hospice Patient Stops Eating and Drinking

Being with someone when they die is an act of grace and should be approached with dignity and respect. Dramatic changes in physical processes like eating and drinking are normal and to be expected. Anticipating these changes will help you and your family keep your loved one comfortable and calm until the end.


Sources:
  1. Geggel, Laura. “What Happens When You Die?”  LiveScience, 9 December 2017. livescience.com
  2. Shaw, Gina. “Pain Medications for Palliative Care.” WebMD, 14 November 2021. webmd.com

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