Nutrition and hydration
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Nutrition and hydration
As individuals approach the end of life, their oral intake often decreases significantly. The desire for food and drink tends to diminish, and dehydration during this time does not lead to discomfort; it is a normal part of the dying process. This stage can be distressing for families and caregivers; hence, providing reassurance and clear explanations is essential.
It is important to recognise that navigating the decision-making process regarding clinically assisted nutrition and hydration can be ethically complex for individuals nearing the end of life and for the professionals involved in their care. This process often entails confronting dilemmas that require careful consideration and a sensitive, person-centred approach. Finally, it is essential to consider cultural and religious beliefs when supporting individuals and their families at this stage.
Key points to remember
- Assess nutrition and hydration regularly to meet individual needs.
- Recognise the meaning of food and drink—they carry physical, social, cultural and spiritual importance.
- Understand that appetite may decrease naturally towards the end of life.
- Provide extra support when certain conditions affect the ability to eat or drink.
- Acknowledge the distress that loss of appetite can cause for both the person and those around them.
- Prepare families and carers for this change to help them understand the dying process.
- Support eating and drinking for as long as the person wishes or is able.
- Communicate sensitively about whether a drip is appropriate in the final days of life.
Remember the 7 Ps
When the desire or ability to eat and drink is reduced, these Ps will help you in delivering care:
- Preference: Establish likes and dislikes.
- Palatable: Food should be what the person fancies, perhaps with cream/ butter to add calories.
- Presentation: Food should be visually appealing and appetising.
- Portions: Smaller plates for smaller portions.
- Position: Ensure you and the person being assisted are in a comfortable position for eating.
- Patience: Let the person take their own time.
- Provide: Good mouth care regularly, whether eating and drinking or not.
Further information
- Symptom management, nutrition and hydration at end of life: a qualitative exploration of patients’, carers’ and health professionals’ experiences and further research questions. BMC Palliative Care
- Artificial hydration at the end of life: balancing benefits and risks in the absence of conclusive evidence. Nursing standard
- Medically assisted hydration for adults receiving palliative care. Cochrane Database of Systematic Reviews.
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