Staff Concerned "We Are Starving Mom To Death"

Dear Barbara,  Will you write about artificial nutrition/hydration at the EOL – still have staff concerned we “are starving Mom to death.”

It is very troubling to me that “staff” would be concerned about “starving mom to death.” Not eating and reduced fluid intake as part of the normal dying process that occurs months before death from disease is Hospice 101.

It is imperative for every hospice employee working with patients and families at end of life to be comfortable and knowledgable in end of life nutrition. So here is Hospice 101 nutrition:

Months before death from disease (add years for old age) a person’s eating habits change. It begins with not wanting to eat meat, then fruits and vegetables, graduating to soft foods, then liquid supplements, then basically nothing.

Food is the body’s anchor to this planet. It is what keeps us going, gives us energy, grounds us. As death from disease approaches the body doesn’t want the grounding, the energy that food gives. The body is releasing its hold on living. It is food that keeps us alive so the body gradually stops eating.

It isn’t that the person doesn’t want to eat, they can’t eat. They try to eat for us but gradually, ever so slowly, they just stop eating.

At this point the entire body is shutting down (generally weeks before death) and physiologically the body is not functioning normally. If at this time you begin forcing food with TPN or feeding tubes/gastrostomy you will generally end up with more complications than benefit---because the body doesn’t want and can't process the food.

About this time, a week or so before death, a person is not taking enough fluids for hydration. Again, the body is letting go, it doesn’t want or need the hydration. Giving IV fluids at this point only increases congestion in the lungs, fluid builds up in the body (the kidneys are not working properly now), creating discomfort.

Yes, people dying from disease die being dehydrated. The interesting aspect to dehydration is that as the calcium in the blood stream builds from the dehydration, a person just goes to sleep and doesn’t wake up. Isn’t this how most people want to die? “I just want to close my eyes and not wake up” is the death of choice.

The following is what I recommend in regards to nutrition as a person approaches the end of life. With months left to live, eat six small, very small, high protein snacks plus four ounces of a protein supplement beverage every two hours from morning to evening. Anything else they want to eat is great. Always offer food, just don’t force it. Let a person eat what they will and don’t worry when they don’t. Nothing bad is happening.

As death gets closer they will gradually eat and drink less of what is offered until they are eating basically nothing. They are also sleeping most of the time, sometimes confused and have withdrawn inward so they are barely communicating. Again, nothing bad is happening. This is how a person dies normally and naturally.

Know the disease has brought about this situation, not the bodily cessation of food and liquid intake. No matter how much food or fluids you get into the body it will still die--because the disease is killing the body. When you start forcing against the natural process you only bring discomfort to the person and their body as they try to leave this world.

Something more... Staff Concerned "We Are Starving Mom To Death"

Food and hydration is a challenging and emotional topic when caring for a person who is approaching end of life. I encourage you read my booklet ALWAYS OFFER, NEVER FORCE: Food at End of Life. 

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