It is common for patients nearing the end of life to experience a decreased appetite and interest in food. As the body starts shutting down, metabolic processes slow down and the need for caloric intake declines. There are several reasons why end of life patients often lose their desire to eat and drink:
Physical Causes
- Disease progression – As the illness advances, it often affects organs and systems involved in digestion like the stomach, intestines, liver, and pancreas. This makes eating uncomfortable or even painful.
- Medications – Opioids and other medications used for pain and symptom relief often have side effects like nausea, constipation, dry mouth that suppress appetite.
- Fatigue – Lack of energy and advanced fatigue make eating difficult. There’s little desire to go through the motions of chewing and swallowing.
- Mouth problems – Mouth sores, thrush, and dry mouth from oxygen therapy or breathing through the mouth decrease interest in food.
- Nausea and vomiting – Gastrointestinal issues make eating unappealing and difficult.
- Bowel obstruction – A blocked intestine, common at end of life, means food can’t pass through normally which leads to symptoms like vomiting, nausea and loss of appetite.
Psychological Causes
- Depression – Loss of enjoyment from food and eating is a characteristic of depression common in end of life.
- Anxiety – The emotional distress and worry of decline and impending death often overwhelms any desire to eat.
- Disinterest – As the body shuts down, chemicals send signals to the brain that suppress appetite and interest in food.
- Control – For some patients, not eating becomes a means of controlling something at a time when they feel they are losing control over their bodies and lives.
Social Causes
- Isolation – Lack of social interaction around meals if eating alone frequently.
- Changes in taste and smell – Foods lose their appeal and do not smell or taste the same, affecting enjoyment.
- Caregiver challenges – Swallowing issues or other eating difficulties can make assisting with meals frustrating for caregivers.
Changes in Energy Needs
As death nears, the body requires less energy. Appetite loss is the body’s natural way of conserving energy as systems start to slow down and shut down.
| Stage of Dying | Energy Needs |
|---|---|
| Final weeks before death | Calorie needs decrease up to 250 calories per day |
| Final days before death | Most food and drink is no longer desired or tolerated |
| Last hours of living | Body shifts to using internal stores only |
With reduced activity and more time spent sleeping and resting, the basic metabolic rate and total energy expenditure goes down. The body aims to maintain a balance, so appetite declines accordingly.
Effects of Reduced Eating
For patients who are very near death and stop eating and drinking altogether, there are usually minimal negative effects initially. However, some potential complications can include:
Dehydration
Lack of fluid intake leads to dehydration, which can cause symptoms like:
- Dry mouth and lips
- Excessive thirst
- Fatigue
- Low blood pressure
- Fever
- Confusion
For end of life patients, intravenous fluids generally aren’t given but care focuses on mouth care and using gels and ice chips to prevent a parched mouth.
Hunger
While not eating leads to a loss of appetite, some patients may experience some feelings of hunger. This is managed through comfort measures and possibly medications.
Skin breakdown
Without proper repositioning and nutrition, patients are at risk of pressure ulcers. Gentle repositioning and protective dressings prevent skin lesions.
Emotional distress
Some patients or families may become distressed seeing their loved one refusing food and drink. Reassurance over the natural process helps ease any angst.
Comfort Care
When patients stop eating, the priority becomes comfort and quality of life in the final days to weeks. Efforts focus on easing any potential suffering from decreased intake.
Managing dry mouth
Swabbing mouth, lip balm, ice chips and mists help prevent a parched mouth.
Support with oral hygiene
Gentle mouth care removes debris and bacteria to prevent infection with reduced fluid intake.
Reposition regularly
Moving the body every 2-3 hours helps prevent painful bedsores.
Continue conversation and companionship
Ongoing social and emotional support provides comfort even when eating stops.
Relieve pain and nausea
Medications treat any discomforts that may arise like pain or nausea.
Monitor closely
For signs of distress from dehydration or hunger that may need additional interventions.
Making the Most of Remaining Time
Even though daily nutrition eventually ceases, patients can still find enjoyment and meaning in their final days. Some tips:
- Focus on favored foods – If interest returns, provide anything that sounds appealing like ice cream, popsicles, mashed potatoes, etc.
- Make mealtimes calm – Reduce noise, bustle and distractions to create a peaceful environment.
- Don’t force eating – All pressure to eat should be removed.
- Try nutritional supplements – High calorie liquid supplements provide an alternative source of nutrients if desired.
- Focus on comfort – Use mouth sponges, lip balm and ice chips to minimize dry mouth.
- Focus on quality time together – Even without eating, mealtimes can involve meaningful conversation.
The shared goal is providing comfort and creating positive final memories together.
Conclusion
Loss of appetite and stopping of eating are natural parts of the dying process as the body slows down and begins shutting down. While nutrition and hydration needs decrease significantly at end of life, some comfort cares remain important like managing dry mouth, gentle repositioning, and relieving any pain. Most importantly, focusing on quality time together and minimizing any distress can help make the most of remaining days.