Decreased Eating and Drinking

Nutrition and hydration is what keeps us alive, as we say “Keeping the body and soul together.” This same amount of intake is not needed by the “dying” — to the degree it is mandatory for the living. Offering healthy, desired prasadam (sanctified food) and accepting it is one of the six loving exchanges among Vaishnavas. This principle also brings a beautiful interaction between the patient and the caregiver until the patient’s body starts to not “need” it due to bodily systems slowing down and deteriorating and not being able to use the nutrition for its purpose which is to “grow and sustain.” Often nothing tastes good to the terminally ill patient and the cravings come and go. Eating and drinking, therefore, is naturally decreased by the patient at the end of life. This is often the most difficult time for the patient’s loved ones who feel their family member is “starving.”

As difficult as it often is, this natural progression needs to be respected and accepted by the family and caregivers as the patient moves one step closer to leaving this world. This is often the most difficult thing for family members to accept. Rest assured, however, that your loved one is not suffering from lack of food. It is natural for the body to save its energy for more important needs at the end of life. 

Suggestions to assist: 

*Ask the patient for his/her needs and desires concerning eating and drinking. Provide choices while he or she is still able to swallow food and liquids. HOWEVER, DO NOT FORCE FEED. This will only cause chocking or other discomfort for your loved one! 

*Keep the “sick room” clean with fresh, circulating air from an open window or small fan placed at a comfortable distance from your patient. This “fresh”
atmosphere may increase his/her appetite. If your patient is using a bedside commode, please remove this from the room during mealtimes to make meals more attractive. 

*Avoid strong smelling foods, such as cauliflower, cabbage, etc. Mild, bland foods prepared without strong spices may be better tolerated by the patient.

*Often liquids are tolerated better than solids.

*Often thick liquids, such as “smoothies” are tolerated more than thinner liquids. (Thinner liquids may cause chocking.)

*Keep your patient’s mouth moist with sips of cool water through a straw, or give tiny 

pieces of ice chips with a teaspoon. This will be a comfort to your patient as long as he can tolerate it without coughing or choking. Be sure the head of the bed is elevated to 45 to 90 degrees or that the patient’s head and chest are lifted with pillows before administering even the smallest amount of liquid or ice chips. Depending on the diet your patient can tolerate and is medically ordered, you may want to freeze his or her favorite juice in an ice cube tray and then break the cubes into chips when frozen. If tolerated, the patient will get more nutrients by sucking on “juice chips” rather than just “water ice chips” and it may be more satisfying as well. 

*Lips should be kept moist for comfort by applying a non-petroleum based lubricant, such as K-Y Jelly, every few hours. If oxygen is NOT being administered, then Vaseline can be applied.  If oxygen is being used then  Vaseline should not be applied because it can cause complications if it gets into the lungs. Again, use a non-petroleum based lubricant if your patient is on oxygen. 

Moisten lips and the inside of the mouth every two hours with cool water by using a disposable, sponge-like “toothette.” (See details on “Changes in Breathing” page.) 

During the last few days of life when even small sips can cause choking, your patient will most likely have no fluid intake. This is most difficult for family members to accept. It should be explained to them, however, that natural dehydration is a part of the dying process and is not painful for the patient. Never force foods or fluids, as this will NOT make your patient comfortable at this time. The body is now conserving energy for more important needs such as the cardiac and respiratory systems.

*It is natural for the body to know which systems to slow down and stop in order to reserve the energy it needs to keep breathing and to maintain the circulatory and cardiac system. Death is a natural occurrence. It is not a medical event. If we simply follow what the patient’s body instinctively knows and not try to go against the “tide,” the death of the patient’s body will wind down in its own natural way. 

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