What happens to someone’s eating and drinking at the end of life?
When someone is in the last days of life, they will often eat and drink less and less. As the body weakens from their illness and people spend more time resting or asleep, they will need less energy and fluids. This is normal. Often, they don’t feel hungry or thirsty or they may find the effort too much. They may cough when trying to swallow and may be too weak to manage even small sips. At some point, they may stop eating and drinking completely.
If someone doesn’t drink, won’t they die of dehydration?
When the body is dying, all the organs like the heart and kidneys start to shut down and to work less well. Food may no longer be digested and fluids are not absorbed well from their gut.
People also tend to get weaker and to spend more time asleep. It is important to remember that this is happening because their condition is worsening as their illness progresses and as part of the dying process. They are dying from their illness and not from the lack of fluids.
What about fluid through a drip?
Fluid given through a drip are usually given into the tissue under the skin (subcutaneous) where it is absorbed. Sometimes fluids are given into a vein (intravenous). For people nearing the end of life, having fluid just under the skin is usually better tolerated.
Would having a drip help when someone is dying or would it cause more problems?
At the moment we do not know enough to answer these questions completely.
We do know that for some people, having fluid through a drip may help reduce problems such as confusion (delirium) that can occur at the end of life.
For others, extra fluids can cause problems like noisy breathing, swelling in their arms or legs or in fact increase their confusion. As well as this, there can be swelling and bruising at the infusion site where the fluids are given.
Would having fluid through a drip help take away the feeling of thirst?
We do not know if fluids through a drip at the end of life take away the feeling of thirst. The small number of research studies that have looked at this have not shown any benefit but more studies are needed before this question can be answered properly.
We do know that as people get weaker, they tend to breathe more with their mouths. This can make their tongue and lips very dry. This may look like someone is thirsty but good mouth care can help a lot. Sucking on crushed ice or an ice lolly or special saliva sprays or gels can be helpful.
How do you decide if fluids through a drip might be helpful?
Any decision on fluids through a drip for a dying person is always made on an individualised basis.
This means taking into account:
- If they have a preference for or against having fluids through a drip
- How awake they are
- How hard it is for them swallow
- How thirsty they are
- Are they at risk of fluids pooling in their lungs and noisy breathing
- Whether they might recover from their illness
Sometimes people nearing the end of their life are too unwell to tell us their wishes. In this case, we will ask those important to them to find out if their loved one had previously spoken of their wishes or about what was important to them.
If it is thought that starting fluids at the end of someone’s life would be helpful, it would be tried for a short period. If it is helpful, it can be continued. If it doesn’t help or causes problems, it will be stopped. This will be looked at every 24-48 hours.
As fluid through a drip is a medical treatment, people cannot insist on having it if it was not thought to be in their best interests. If this was the case, they will continue to have high-quality care with their symptoms managed as much as possible.
When might fluids not be helpful?
When it is clear that someone is actively dying (hours to short days), the burdens of starting a drip will usually be more than any benefits. In this case, we will focus on making sure they are comfortable and their symptoms managed as best as possible.
When people have advanced heart failure or conditions where they have a lot of fluid collecting in their lungs or tummy, giving fluid through a drip can make them feel worse and would not be helpful.
What happens if fluids are being given by a feeding tube?
If someone has a feeding tube in place already, they can often continue to have fluids through this. As they near the end of life, the benefits and burdens of continuing this will be discussed with them and those close to them. A decision to continue, reduce or stop as they near death will then be made.
If someone does not have a feeding tube in place, it would not be the right thing to do at this stage as they will be too unwell to tolerate this.
Would having fluids make someone live longer?
We do not have a clear answer to this question yet. A small number of research studies have not shown that fluids for someone who is dying helped them live longer.
What can I do to help?
Offer drinks if your loved one wants to but don’t be surprised if they only want a few sips at a time. Using a beaker or a straw can help. Sometimes a thickener can be added to water or tea. This can help some people swallow better but this can also change the taste of the drink so some people may not want this. Help them with keeping their lips and tongue moist and staff will be happy to help you with this.
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