Chapter 2: Explaining common clinical issues

Loss of interest in food and fluids

The palliative care expert says
Lawrence Chung explains the importance of food in Chinese culture and provides a strategy for navigating "the need to feed".(3:22)Video transcript

As death approaches, a patient’s desire for food and water diminishes and then stops. This is one of the most difficult changes in the illness trajectory for family members to observe because it is a basic act of nurturing, caring and connection. They may also hope the person will become stronger with food and drink. In addition to the personal desire to provide sustenance and nutrition, many cultures have rituals and beliefs associated with eating together and feeding someone.

Risks of food and fluids

Forcing the patient to eat can increase the risk of choking, congestion and greater discomfort. They may have difficulty swallowing and sometimes need pureed food, if they wish to eat at all.

Explaining nutrition to the family

  • It’s common at the end of life for people to stop eating and drinking. 

  • Eating may make them feel uncomfortably full, bloated or nauseated.

  • Their body can no longer use the energy and nutrients of food. 

  • They won’t gain weight even when they try hard to eat more.

  • They won’t gain weight even if given food through feeding tubes or intravenously.

  • Providing food at this stage doesn't improve their energy, strength or survival.

  • The patient may feel distressed and blamed when they’re told: If you’d just eat, you’d get stronger and better.

Other ways to help

Family members often feel helpless as they watch someone important to them become increasingly weak and thin – and can do nothing about it. You can support them by suggesting other ways to help. For example, patients with no appetite, or who have difficulty swallowing, often have an uncomfortably dry mouth. Family members can help them with: 

  • Ice chips and hard candies to suck on (if swallowing isn't an issue).

  • Good mouth care.
    • Swabbing the mouth with water or salt water.
    • Or spraying a mist of water into the mouth.

  • Over-the-counter mouth moisturizer products. (Their local pharmacist can make suggestions.)