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Eating and drinking at end of life

End of life

In the final stages of a life-limiting illness, when someone is approaching the end of his or her life the focus of care for the person may change and tends to be centred on helping them to be as comfortable as possible.

Food and drink

At this time, people often experience a decrease in appetite and a loss of interest in food and drink.

This can be concerning for families and carers but it is a natural and expected part of the dying process. Most people at the end of life do not experience hunger or thirst. The body is slowing down, and if someone eats or drinks more than they really want to it can cause them discomfort.

Families and carers may be concerned about the effects of reduced food intake or dehydration on the person who is dying, and it is natural for families to want to continue providing nourishment at this time.

Nutrition or nourishment?

At this stage of life, meeting nutritional needs becomes less important than providing comfort, and even very small amounts of the person’s favourite food and drink can provide comfort.

Tube feeding fluid via a drip or ‘food’ via a feeding tube do not usually provide comfort, improve quality of life or prolong life and can be uncomfortable for the person who is dying.

Prescribed nutritional products do not contain anything which can’t be found in food, they are not appropriate to prescribe in the last days of life. Most people seem to prefer the flavour of ordinary food. Food means much more to most people than simply nutrition, and at the end of life enjoyment of even small amounts of food and fluid is more important than its nutritional content.

Many families find it helpful to look at other ways in which they can provide ‘nourishment’, comfort and support for their loved one.

Other ideas that may help

  • Keep asking “what is helpful for this person at this time?” – there is no single ‘right’ answer as it depends on each person’s individual situation
  • Continue to offer other forms of support such as gentle massage, skin care, music and conversation
  • Keep the person company – talk to them, read to them, watch films together, or simply sit and hold their hand
  • Even when people cannot speak or smile, their need for companionship remains. The person may no longer recognise you, but may still draw comfort from your touch or the sound of your voice

What about food?

  • Let the person choose if and when they want to eat or drink
  • Offer small amounts of food, especially the person’s favourite flavours
  • Don’t worry about providing a balanced diet
  • See below for ideas for small snacks and nutritious drinks and see Food first – Homemade supplements for homemade supplement recipes

What about drinks?

  • Frequent mouth care (gently brushing teeth with a soft toothbrush) can prevent the person feeling thirsty, even if they cannot drink very much
  • Keep lips moist with lip balm
  • Use a small spray bottle to mist the mouth with water as tolerated
  • Offer small pieces of ice or small ice lollies instead of drinks

Small snacks

Small portions of food, which do not need a lot of chewing may be easier to manage.

Suggestions:

  • Mini tub of yogurt, fromage frais, dessert or custard (often sold in multipacks)
  • Mini ice cream lolly or mini tub of ice cream
  • Small pieces of prepared, soft fruit e.g. mango, melon, grapes, orange segments
  • Favourite sweets or squares of chocolate
  • Small pieces of scone with butter and jam or lemon curd
  • Mini tub of cream cheese or cheese spread – these could be served with soft bread
  • Quarter of a sandwich with a soft filling e.g. egg mayonnaise, tuna mayonnaise, paté
  • Cocktail sausages, mini sausage rolls, mini quiches or mini scotch eggs
  • Squares of cheese
  • A few ‘soft’ crisps such as Quavers or Wotsits
  • Breakfast cereal with milk e.g porridge or Weetabix

Drinks

Small cups or glasses may be easier to manage. If the person can only manage half a glass or cup, they may still find it easier to drink from a full cup or glass. This can make swallowing easier because the person does not have to tip their head back as far.

Sips of citrus flavour drinks e.g. lime cordial, lemon squash may help if the person has a dry mouth.

Suggestions:

  • Milkshakes
  • Milky coffee
  • Hot chocolate
  • Malted milk drinks
  • Smoothies
  • Fizzy drinks or fruit squash (try to avoid sugar free, diet and no-added-sugar varieties)