Food and the Dying Process

Hi Betty, I really don’t have enough medical history of your mom to know if she has entered the dying process (because of her age and/or disease). She does have the signs I look for, decreased eating, increased sleeping and withdrawing, that tells me a person has entered the dying process. That said she could just be severely depressed. You might think of a mild antidepressant and see if that makes a difference. My guess is it probably won’t. You didn’t tell me if dementia is part of your mother’s medical history. If it is then that is also a factor of what is occurring. What would I do if she were my mom? If dementia isn’t a factor, I’d tell her I was worried about her and why and listen to what she tells me. At 82 with her medical history I would offer advice and offer food, but not force. I would suggest she leave the house with you, go someplace but if she refuses that’s okay. Offer, suggest but accept. My blessings are with you and your mom. Barbara

Hi Barbara! My mom, 82 , was diagnozed with stomach cancer 2 years ago, She refused operation and had 6 cycles of chemo with little improvemnt on CT scans but big improvement in her performance. The disease stopped and she is off treatment for 15 months now. 4 months ago she started losing weight again and although CT scans shows very little progression, my mom is feeling worse and worse. I am confused to what extend her symptoms relate to disease itself and to what they might be caused by mental issues as she was always very neurotic and had symtopms that were not related to any real diseases. She eats very little and stopped going out. She spends most days lying down and sleeping, avoids talking to friends. She is not taking good care about her hygene but does not allow me to help her with that or change her bedsheets. Should I fight over these things or leave her alone and allow her to not eat? She is able to swallow solid foods, just doesn`t want to eat.

Hi Lois, about your mom not eating for 6 days and now beginning to eat—has she entered the dying process? I’m with your hospice staff, I don’t know. Alzheimers is such a tricky disease. It just doesn’t play by any rules. My thoughts are she could be experiencing what I call the "calm before the storm”. She appears to be days to hours from death, then perks up for a few days and then resumes actively dying. Another thought is something could have been occurring in her body that balanced itself. Bottom line we will probably never know what happened or why. I know this has been difficult, preparing for and anticipating her death only to be faced with questions as to what is happening.
My blessings are with you all. Barbara

My mom is dying of copd,chf,late alzheimers. She went 6 days no food water, no output, glassy milky eyes rolled back, talking to loved one who past. She started drinking water yesterday, still confused really weak, today she ate 3 bites of roasted potatoes. Which is crazy. I don’t know if it’s a burst or shes getting ready to pass. Hospice says it could be a bust or spiritual change. Is this normal?

Hi April, a few times I have seen a person reach death’s door and turn around and come back for a while. This doesn’t happen very often but what a gift when it does. I don’t know the medical reasons for this to happen. My take is that the person gets close and says “Wait a minute. There is something I need to attend to.” We will probably never find out what that “something” is. Our part is to take the gift of having our loved one with us a bit longer. Blessings to you and your mom. Barbara

Yes I have a question. My 93 year old mother was diagnosed with pancreatic cancer 7 months ago and has been on hospice for 6 months. About two weeks ago she was not eating or talking mostly sleeping. We thought she was leaving. Then she started feeling better and started eating again and talking a lot. It has been about 2 weeks for this Improvement. Everyone is shocked even the hospice people. Is this a common occurrence?

Hi Carolann, I don’t have a enough medical history to be able to put a time frame on your father’s progress. You might find my booklet Gone From My Sight helpful. You will be able to see signs that occur weeks before death, then hours and minutes. It can give you some guidance. You might talk with his doctor about a hospice referral so you both have support.
My blessings are with you, your father, and your family. Barbara

Hi BARBARA, this is the first article I’ve seen that actually explains the process of dying from old age. My father is 96, almost 97 and for a number of months now has gradually decreased food and liquid intake along with social withdrawal and increased sleeping. My family and I have been worried, thinking he was dying but not having confirmation from health professionals. I feel so relieved now, having read your article. I won’t nag him anymore to eat or drink, I believe he has the right to do whatever it is that makes him happy.
One question – I find it so difficult trying to predict how long this process will take and have had my life on hold now for several months. Can you give me any idea re timelines please? My father has always been very healthy, has some renal failure, some high BP and some atrial fibrillation.

Hi Cathy, based on what you have described of your mother’s behavior it does appear she is in “labor’ to leave this world. Labor is usually weeks but there are so many dynamics to dying that no one can be specific—it is always a guess. What can you do? Sit with her, hold her hand, talk with her even though she doesn’t respond. Tell her your comings and goings. Tell her you understand she is leaving you and she can go whenever she is ready. Talk about the good times in your life and talk about the challenging times also. She will hear you even though she may not be responding. If you have not read my booklets Gone From My Sight and The Eleventh Hour they will be very helpful to you right now. You might want to get the ebook End of Life Guideline Series so you can have the information now rather than wait for the US mail. If she is still here next month you can reevaluate whether you need to return to work. If you do, tell her of your struggle, how hard it is to not be with her during this time but you need to pay your bills. Know that some part of her will understand. You can always stop in after work and sit with her for awhile. If she is your best friend then she knows how much you love her, want to be with her. You’re doing a good job of loving and caring for her. I’ll bet she knows this.
My blessings are with you and your mom. Barbara

Hello, and thank you for this blog. My mom is 81, she has COPD and is in stage 4 of renal failure. She took a fall last September, and I remember thinking, this is no big deal, I called the paramedics. She was unable to walk. She didn’t want to go to the hospital, but I insisted. I did think it would be simply an overnight thing. But, it turned out she was in the hospital (her muscle and heart enzymes were way out of wack, but she did not have a heart attack).

She was too weak to go back home, so she went into a rehabilitation center. She was there for almost four weeks, and not getting stronger.

Although I said I would never put her in a nursing home, I had to. I felt she needed care 24/7, which has turned out to be very true. She has fallen, she shows no interest in anything, even TV, which is very different from where she had been. She just sleeps, and if she is not sleeping, she is just not there. She has COPD, so that, in and of itself, makes it hard for her to talk. She has not eaten but a few bites of pudding, in over three weeks. She doesn’t drink water, but she loves McD’s coke, She knows the difference, between that and regular coke, lol. I brought her her favorite milkshake the other day, she took one bite, and didn’t want the rest.

I brought in Hospice last week. To be honest, I am not very impressed. They did an evaluation, the nurse visited once, and they brought her a bed that will not allow her to fall out.

When I was there last night, she appeared to be awake, with her eyes wide open, but she wasn’t blinking…or at least very little. She would not take water, and only a few sips of coke. I have taken a leave of absence from work to be with her. I try to talk to her, tomorrow I am bringing in her favorite music.

I am crying right now, because I feel at a loss as to what to do. Taking the leave of absence is a wonderful gift, but I am struggling financially; I am struggling between my desire to be with her and also go to work. I really think she doesn’t have much longer to live. I want to be there for her.

After reading so many posts, I feel at odds with myself. I don’t want to be selfish, she is my best friend. Not knowing if she is for certain passing in the next month, or if it will be months, has my stomach in a knot. I feel she is ready to go, I don’t want her to go, yet, she has no quality of life, so I want to let her know it is ok to go. Oh my lands, this is an internal struggle for me. And I feel selfish.

Any suggestions would be greatly helpful. Thank you so much for this wonderful forum!

All the best,

Cathy

Hi Denise, to answer your question of why meat is the first food we stop wanting to eat as we enter the dying process: my guess is because meat is a grounding food. It provides large amounts of protein and protein is a building, growing part of food. As the dying process begins the body is stopping growth, stopping building. It is trying to shut down, to stop. As I said that is a guess but seems logical. Don’t know if any research has been done on this particular aspect of dying. Thanks for asking. Blessings! Barbara

Why is meat the first food item to be refused during the dying process?

Hi Mary, in response to your comment about your mother’s dementia and decline and you wanting to have her on hospice; Dementia doesn’t play by the rules which means your mother’s decline may not indicate she has six months or less to live (which is the requirements for hospice). That said, not all doctors are comfortable with hospice. Not knowing your mother’s complete medical history I can’t say if hospice is appropriate or not.
You might talk with the nursing facility staff to see what their thoughts are on hospice and if they work with a particular one. Have their hospice do an assessment visit to see if she is appropriate. You can then have the nursing facility physician talk with her doctor. The nursing home doctor can make a hospice referral. This is a difficult time for you, your mother not so much. Her world is now different than the one we are used to. Love her, talk with her as if she understands and be there. Have you read my booklet How Do I Know You? It is about dementia at end of life. You may find it helpful. If I can be of any help use my personal email barbara@bkbooks. com. Blessings to you and your family. Barbara

My mom has been in the nursing home for 4 1\2 years with deminta and has been sleeping most of the time. There is little or no conversation with her. What she says makes no sense. She has lost weight I would say she weighs only about 100 lbs. We would like her to be put into hospise (my sister and Step-dad and myself. She is not ever going to get better. The Dr won’t put her into hospise. She always says she wants to died when she does make sense. Is there anything that we can do?

Hi Russ, thank you so much for sharing your thoughts about the death of your beloved poodle. For many of us our animals are also our children and our loss of them is heart wrenching. What I have learned from working with end of life all these many years is that animals die the same as humans. They withdraw, sleep more and eventually stop eating. Their hours to minutes are the same as well, even breathing like a fish just before they die. The physical body, animal and human, has always died this way. Either fast or if gradual following the same pattern. This is how the body dies. How we deal with approaching death what has changed over the centuries.
Again thank you for sharing. My blessings are with you. Barbara

Thank you for this post. I know this is about humans but feel i have to share my thoughts, i understand if you do not want to include this in your comments. I had to google my poodles symptoms towards the end and found comfort on the words above. Our beloved standard poodle of 12 years virtually stopped eating and lost a lot of weight and became less interested in going out. Otherwise he was ok, had a heart murmur, grade 1 recurring cancer on the rear leg and three elongated bones in his back, and food intolerance’s. To find that we all decide to stop eating before we die is so awful, but so nice, We helped him along the way and gave him a state burial with his bed, toys with our own hands. I could never go through this again though, i am sorry, it was just too painful for me. I do feel blessed having shared his life,

Dear Barbara
Thank you so much for these additional insights and wonderful knowledge. I have been an R.N in the emergency room my whole career, I recently came to work as a hospice nurse and was afraid I wouldn’t be able to get out of the “saving the life” mode and transition to helping those at the end of their life pass with dignity and comfort. I have had more personal experience with my sister, mother, and my spouse of 34 years all died in my home with hospice by their side and mine. Having those experiences and the wonderful team of caregivers that I work with now at new Century Hospice,
encourages me to continue this path that I believe was chosen for me to comfort,guide and help to educate my patients as well as their loved ones thru the transition of dying in a loving,and peaceful, pain free, and gentle pathway. Thank you again for your professional and knowledgeable insight for all of us.?

Hi Mary, it is very hard being a primary caregiver and having those relatives not directly involved in the care critique the care you are giving. This is a common occurrence but that doesn’t make it any easier to live with.
From your descriptions of your mom, the care you are giving her, and hospice’s involvement it looks to me like you are doing just what you are suppose to be doing.
End of life care is not about routines and following regiments. It is about thinking of the comfort of the patient first. The only reason I would wake someone up for medicine is if it is pain medicine. (that must be on a strict schedule around the clock to maintain comfort) Meals and other meds are just not that important. Always offer but don’t force. 
When to stop medications (other than for pain) depends on what the meds are being given for. Many times people are taking medications because they always have, not because they really need to be taking them now. I have taken many a person off their routine meds months before death and they actually perk up because the side effects of the drugs are gone. Ask your hospice nurse what she thinks about taking her off medications. My blessings to you and your family. Barbara

Dear Barbara- My siblings and I have been caring for our mother, who suffered a mild heart attack and a second stroke almost
three years ago. She has been bedfast and under hospice care since mid-February of this year. As Mom has declined, her eating
has decreased significantly a vast majority of the time. Having read your blue booklet.“Gone From My Sight…”, plus speaking to hospice nurses, I am able to accept this change- not insisting she eat or drink- as well as realize that sleeping much more is also a part of the dying process. My sisters are more insistent that we attempt to arouse/awaken our mother to ask if she wants any food and/or drink; even if not, they want to give our mother her medications, on schedule, as much as possible. One time,I allowed her to sleep, rather than disturb her to take one medication; this displeased one of my sisters. Is there a time when some or all medications are stopped? Who determines this, and when? Caregiving has been a real challenge for me. The pressure from my sisters regarding our mother’s intake and medications is causing anxiety. I do not want to be considered neglectful or abusive.I’m caring
for our mother the best I can; the hospice nurses have tried to reassure me that I’m doing right by my mom. Thanks.

My dad passed Oct 2, 2016. Your dying process is right on. If only caregivers could all understand.

As a long time Hospice volunteer I really appreciate this informative article, Barbara !!

What you write is very true. NEVER force a dying patient to eat or drink.
Give them lots of love and caring.
And don’t talk about any subjects which might upset them.
Hearing is the last thing to go…… Ronee Henson

Decreasing food intake brings up so much for the family/carers possibly more so that the person who is dying. We attach so much meaning to what food is. When families/carers see that food intake is declining it’s confirming to them that this person is actually dying.

I have had a few family members recently ask me about giving nutritional supplements, given there family member was eating very little. I was very gentle and honest about the little difference that it would make.

I feel it’s important that we each deeply consider what food means, but also how we use food in our life even way before we die. Such as do we eat (or drink) to check out of life or numb how we are feeling in any way? Do we use it to distract ourselves?

The food we choose and the way we eat is so much more than meeting our bodies nutritional needs.

Hi Alicia
You need to educate the caregiver about food at the end of life in a gentle but direct way. Tell her what you are telling me in your comment. Also, do you have a copy of New Rules for End of Life Care? This is a helpful tool you could watch with her to reinforce what you have said about food at end of life. I talk extensively about food in this 25 minute film. If you would like to talk more you can email me at barbara@bkbooks.com. Blessings Barbara

Hello Irene
I really don’t have have enough information about your mothers health situation to know what’s happening. Having said that, I do wonder if when she started comfort care perhaps they took her off a medication that had side effects. That could be the big change in her eating/choking and why it was happening then all of the sudden not happening..
My thoughts and blessings are with you and your mother at this time. If I can be of assistance please feel free to use my personal email, barbara@bkbooks.com

Barbara, my mom die May 2017.

After reading the food and dying I recognize all the steps. We took care of mom at home for 2yr 6 mos.

She fed her very small pieces of meat in her food, some how she remove it from her month. Then went to vegetable, then only ice cream. Then did not swallow not even water. Anything would choke her. Then offer food but no taker.

We realized this was part of the dying process, closing shop.

The article bring back so many memories of the last 2 years 6 months.

frank

I have a hospice patient, dx is Alzheimer’s. He is total care, spouse feeds him etc. but he is compulsive eating. Everything she attempts to feed him, he eats. He has dysphagia so foods are soft. My dilemma is that he has recently started having very loose stools and during my visit this week he had a Bm and I cleaned him up. This graphic but the food wasn’t fully broken down. I explained to her that he didn’t seem to be digesting and obviously not absorbing nutrients as his arm circ has decreased over 1 cm in the last month. I need advice on how to convince the caregiver on decreasing his feedings. It wouldn’t be as much of an issue if he wasn’t compulsively eating. She thinks he is hungry so she keeps pushing it to him. Thank you for any input.
Alicia, RN

I remember when my brother was dying. His meals were untouched. He’d scan the menu and choose his favorite foods and yet when they delivered, he’d barely eat. One day he said he’d really like to try a blood orange. I went to the market where I knew they had them and brought him back one. I don’t think he even had half a slice of it. Of course when he was moved to hospice, the only thing he could manage was a little sponge dipped in ice water. It was heartbreaking watching him fade before my eyes. I love how you explained that food ties them to earth, the most basic tie to the here and now. Although this is bringing back so many memories and so much emotion, I understand this transition so much more thanks to your lovely and gentle explanation, Barbara.

My mother passed away in December. This was very true in her case. She would hardly touch any type of food except for an occasional cookie or couple of spoons of ice cream. This went on for several months before her death. Her last week with us, she’d very seldom even take water. Upon death she weighed a mere 78 lbs.

Barbara, thank you for your insight into the transition process. My question is: my mother is transitioning. At 84, she has been on Hospice Care for 4 months, comfort care for.3.weeks. She actually went 2 weeks without eating and not liquids other than to swallow pills, which made her choke. Right before I was going to introduce a thickening agent her choking went away and her appetite returned somewhat. She is now eating at least once a day. She is confusing me, to say the least
Any insight?

Diane, I agree with you. Thank you for pointing that out.

Hi Kathie, at 91, with no active disease process other than dementia, I think it is fair to say, just by nature of her age, that she is “wearing down”. Gradual death occurs in two ways—gradual or fast. Gradual death is either old age or disease. With old age it can take years of a slow progression of the same things that occurs over months in someone dying from disease. Watch for increased sleeping and decreased interest in actviites. Remember to always offer food and fluids. You might try giving her the small, high protein meals I suggested in the blog article.
Blessings to you in the work you are doing. You are a front line worker and very valuable. Barbara

Mary,
In response to your question I wonder what the disease process is that required the person to be in an induced coma from powerful pain medications. Has the dying process begun? Is the person fixable if they are brought out of the induced coma? So much information I don’t have. I can say that IF THEY ARE IN THE DYING PROCESS ( the key element here) they are not hungry or thirsty. Actually if you give them IV fluids you will be making them more uncomfortable with fluid build up in the tissues and lungs.

It is absolutely a “good idea” to educate the family as to the what and why everything is happening. Knowledge reduces fear as well as misunderstandings.

What if the dying person is in a coma due to the effect of powerful pain medications….What if they are hungry or thirsty but are UNABLE to communicate that they are are suffering from thirst o r hunger pangs? Should they be given nourishment by IV just in case? WOuld it be a good idea to prepare the dying person and family members of these eventualities before they happen so the process can be better understood and discussed as it unfolds ? Family members are often upset when this process of “perceived?” suffering takes a long time… Mary Anne Schinkel

Hi Barbara,
I am a caregiver for a 91 year old woman who does not have a terminal diagnosis. She has dementia and serious memory issues, lives in her own home, next door to her daughter who is the one who hired us for companionship and meal prep. Lately I have noticed she is sleepier than usual and does not have an appetite. Sometimes she will eat if you prepare something for her, but sometimes she just refuses. I know that without a physical exam, you are probably reluctant to,make a determination, but do you think this could be the beginning of what you describe above? Could she just be “wearing out”?
Thank you for your compassion in education and informing about end of life issues.

Barbara’s explanation about the natural dying process and the loss of desire to eat is helpful. The problem I have with this is that the questioner seems to be considering declining to have her mother fed because she is no longer able to feed herself. Her mother may very well desire to eat but does not have the capacity to do it herself. Feeding is one of the most basic ways to care for people. If her mother refuses to eat in the process of being fed, that is a different story. But not offering to feed her mom would be morally objectionable, in my opinion.
Diane McCarthy, MA, BCC

This advice has come just in the nick of time for me Barbara. I am currently watching a close neighbor and friend take the last steps before death. He too is only able to eat ice-cream and is on hospice or ‘comfort care’ but is in the hospital, so I feel unable to be the doula I know he wants me to be. Hospitals take away the natural part of death, and this clinical part of his life is alien on so many levels. At least now I can explain his lack of eating and your gently encouraging words of advice, to his family. Thank you! Barbara Dunn

Barbara, thank you once again for your sound advice. Something I noticed about my mother in her last few days is that when she was offered ice cream (her favorite food), she would respond and have a few bites. We buried her with the lid of an ice cream container in her casket and had an ice cream social at her memorial service. She was over 100, so her passing was not an unexpected event…and ice cream had a part. Thinking retrospectively, I realize the significance of food, if not just as a memory.
Leah Kinnaird, RN