Practical advice and comfort measures for caregivers present during the final days of life.

As death approaches, people often experience a decrease in appetite with little or no interest in food and drink. They may be unable to digest food or to take fluids by mouth.

While a decrease in appetite and thirst is not painful and is an expected part of dying, it can sometimes be worrisome. People are often concerned about reduced calorie intake or the effects of dehydration.

It is natural for families to want to continue providing nourishment at this time. In specific situations artificial hydration (such as intravenous fluids) can be beneficial. Generally, however, hydration does not improve comfort or prolong life. In order to make the best decisions about
hydration it is important that the patient, family and health care team work together.

Your physician, Home and Community Care Nurse or hospice palliative care team can offer information and advice about the role of food and fluids and ways to handle decreasing intake.

Discussions about nutrition are important. As death approaches, peoples’ needs and wishes can change, making it necessary to keep asking, “what is helpful for this person at this time?” There will be no single ‘right answer’ to this question, as it will always depend on the unique circumstances of each patient.

Helpful Things To Consider

• Decreasing food and fluid intake is a common, natural part of the dying process.
• Most dying people do not experience thirst or hunger as death approaches.
• Giving food and fluids by artificial means (e.g., intravenously) does not usually prolong life or improve its quality.
• Providing food and fluids by artificial means may, in fact, increase distressing symptoms such as shortness of breath, respiratory congestion, restlessness, nausea and vomiting.
• When people have difficulty swallowing, eating and drinking may put them at risk for choking.
• Artificial hydration does not provide nutrition.
• Artificial hydration does not usually prevent or improve thirst or relieve a dry mouth.
• Frequent mouth care can help relieve a dry mouth. (See General tips for mouth
  care.)

Providing Care and Comfort
General tips for mouth care:

• Keep lips moist with petroleum jelly, water-soluble gels, artificial saliva or unscented moisturizer.
• Use a moist cloth, soft toothbrush or plain mouth swab to wipe the mouth; avoid glycerine and lemon swabs, which can dry the mouth further.
• Mist the mouth with water, being careful not to give too much.

When the person is still able to swallow safely:

• Give mouth care, as above.
• Let him or her decide on the amount of food and fluid wanted.
• Offer ice chips or popsicles.

When the person is no longer able to swallow:

• Continue mouth care, as above.
• Consider offering other kinds of support such as gentle massage, skin care, music and conversation.

After Death

This final leave-taking can be a difficult time. You may wish to spend time with the body of the person who has died, reminiscing and saying good-bye.

Before the funeral home attendants arrive, you may want to bathe and/or dress the person or send special objects or notes with him or her. You may prefer to choose the clothes you want the person to wear and give them to the attendants, or you can bring them to your meeting at the funeral home.

When the funeral home attendants arrive, they will move the body to a stretcher in preparation for leaving. The body will be placed in a special zippered bag made for the purpose of transport.

Consider whether or not you wish to be present when the person’s body is removed. You may wish to remain with the body or you may want to leave, go into another room or go for a walk while the stretcher is taken out.

Memorial or funeral plans can be made or confirmed at an appointment with the funeral home the next day.

Ask your health care team about local bereavement resources available from the hospice society or other services in your community. Even normal grieving can have a profound impact on you and support can be beneficial for your on-going health.