The Role of Nutrition & Hydration at the End of Life

glass of waterNutrition and hydration are important in our lives from the time we take our first breaths. Our culture places a significant emphasis on food and drink. Providing something to eat and drink for a loved one is often a way of communicating love, concern and caring in a direct, nonverbal way.

Terminally ill individuals don’t consume food and drink in the same manner they always have; a decrease in appetite and thirst is a natural progression of the body slowing down. You can expect your loved one to reduce food or water intake at the end of life. It’s important not to force your loved one to consume food or fluids.

Allowing people to eat and drink what and when they want as they near the end of life is beneficial to not only the terminally ill person, but also to their caregivers. Pushing or forcing food and liquids can cause unnecessary hardships for the caregiver, such as feelings of guilt and rejection. Our bodies know what they need and give us messages about what we need to do to sustain life. The sustaining value of food and fluids is often not important to the terminally ill person. Many times the disease process alters taste buds, making foods taste bland, salty or sour, or water to have a metallic taste.

Diminished hunger and thirst (and resulting weight loss) is part of the ongoing disease process and assists in adapting the body toward a peaceful and comfortable death. There is no evidence that increased oral intake (food or fluids) prolongs life or relieves suffering in individuals with terminal illnesses. The person will naturally limit the intake of food and fluids as his or her condition declines and less energy is needed.

You can expect changes in the level of alertness as the body slows and nutrition needs decrease. Dehydration has been observed to actually decrease the symptoms of nausea/vomiting, incontinence, pressure from swelling, congestion, shortness of breath and cough. Dehydration also may cause the body to release chemicals that may decrease pain. Because of this, using artificial means of hydration, such as IVs or tube feedings, can actually lead to more side effects and discomfort.

Factors that Decrease Appetite & Fluid Intake
  • Change in taste of foods and fluids
  • Nausea and vomiting
  • Constipation
  • Bowel tumors and/or obstruction
  • Liver and pancreatic cancer
  • Pain
  • Weakness and fatigue
  • Chemotherapy and radiation
  • Breathing problems
  • Medications (narcotic and non-narcotic)
  • Bleeding gums and/or dental problems
  • Abdominal cancers (generalized)
  • Ascites
  • Difficulty swallowing
Helpful Hints for Good Nutrition
  • Offer small, frequent meals high in protein throughout the day rather than maintaining a three-meals-a-day routine. Five or six meals a day of light food are more easily tolerated. Suggestions include nuts, hard boiled eggs, meat and cheese, and Greek yogurt.
  • Maintain hydration through small, frequent sips of fluid throughout the day between meals, instead of with meals to prevent feelings of fullness.
  • Alter the time of meals to when the patient is pain-free and has the most energy (e.g., morning, mid-afternoon and after pain medications).
  • Purée family meals for patients who have a hard time swallowing.
  • Don’t force food or fluids at any time. Forcing foods and fluids will cause both physical and emotional discomfort.
  • Liquid meals are often best when the person is nauseated or in pain.
  • Ice chips or flavored freeze pops may relieve the feelings of dryness and discomfort when the person no longer wants to eat or drink. You can also offer drinks containing electrolytes, such as Pedialyte or Gatorade.
  • Baby food can satisfy the need for soft, bland food. Make it more appetizing by adding spices and seasoning.
  • Cups with lids, like travel mugs, allow a weak person to drink by him or herself without worry or spilling.
  • If your loved one is unable to sit at the table for meals, and if he or she so desires, try having the family use trays and eat meals with the person wherever they are most comfortable.
  • Experiment with flavor to make food more appealing. Season foods with tart flavors, such as lemon, lime, other citrus, vinegar, or sweet and sour sauce. If your loved one says foods taste too salty, try adding a sprinkle of sugar. If foods are too sweet, add salt. If food is too bland, try other herbs and seasonings.
  • If your loved one complains of a metallic or bitter taste, or of dry mouth, give the person lemon drops, mints or gum for relief. Avoid metallic containers or metal utensils because they can leave a residual flavor. Instead opt for plastic, ceramic and glass.

About Hospice of the Red River Valley
In 1981, Hospice of the Red River Valley was founded on the belief that everyone deserves access to high-quality end-of-life care. We fulfill our nonprofit mission by providing medical, emotional, personal and spiritual care, as well as grief support to our patients, their families and caregivers during a tender time in life. Our staff helps those we serve experience more meaningful moments through exceptional hospice care, 24 hours a day, 365 days a year, wherever a patient calls home. The organization serves more than 40,000 square miles in North Dakota and Minnesota, including in and around Bismarck, Detroit Lakes, Devils Lake, Fargo, Fergus Falls, Grand Forks, Lisbon, Thief River Falls, Valley City and many more communities. Hospice of the Red River Valley offers round-the-clock availability via phone, prompt response times and same-day admissions, including evenings, weekends and holidays. Contact us anytime at 800-237-4629 or


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