Eating and Drinking: The Changes During End-of-Life
Feeding and keeping a client hydrated are built-in skills for caregivers. When caregivers serve clients their meals and they see most of the food left on their tray, they can experience mixed emotions.
Caregivers ask themselves, “What did I do wrong?” or “How will my client get better if they don’t get all the nutrients they need?” They have thoughts like, “I’m afraid their illness will get worse if they don’t eat right.” They start feeling guilty, worried, and eager to find a solution.
Now, this is a good thing for most clients because it means that their caregivers are attuned to their needs and are committed to ensuring that those in their care receive proper food and hydration. But for those clients who have a life-limiting illness or those who are at the end-of-life stage, it is a different story altogether, because eating and drinking patterns change as the client nears death.
As clients near the end of their life's journey, their body prepares for a complete shutdown and they may lose some of their bodily functions, including their desire to eat and drink. They have difficulty chewing and swallowing. Some clients, such as those with late-stage Alzheimer's disease, will not be able to eat and drink at all because they have already lost the functions of their mouth and throat.
What can caregivers do during this time?
1. Whatever you do, always check with the care plan. Changes happen in stages, too. For example, those on a restricted fat diet may be allowed pizza and ice cream in the hope that it could increase their food intake. In their last days, artificial or tube feedings may be given instead. Some will have instructions to withhold food and water altogether.
2. If clients can still eat:
a. Always feed the client in an upright position, especially if bedridden. You can do this by helping them sit on a chair or by raising the head of the bed. This position assists in digestion and more importantly prevents choking and aspiration, which is getting food in the airways and lungs instead of the stomach.
b. Offer fluids frequently. This strategy will keep them hydrated and will help preserve their bodily functions.
c. If swallowing is a problem, thicken their food and drinks by using thickeners such as cornstarch or gelatin when preparing meals. You may also use commercial food thickeners that are available in the pharmacy. Pudding, milkshakes, and thick soups are best to serve at this time.
d. Give “comfort foods” or their favorites, if allowed. Letting them eat their favorite foods will help them feel good and encourage them to eat adequately.
e. Do not expect them to finish their meals. Clients at the end of life will either eat too little or refuse to eat altogether. Offer small, frequent meals instead. If they cannot be encouraged to eat more, even if they are offered their favorite foods, inform the supervisor and document these findings in the client's health records.
f. If the client cannot eat anymore, such as when they are always drowsy or unconscious, or if they refuse to eat and drink by choice, provide mouth care and moisten their lips using a sponge dipped in water or with a lip balm. This stage could take hours or days. In their final moments, going without food and water causes bodily changes that bring about calmness.
At the end of life, clients will show changes in the way that they eat and drink. Whether giving or withholding food, the most important thing is to keep them comfortable and well-cared for.
