Eating and Drinking at End of Life
As you near the end of your life, your body slows down. It does not need as much food and drink as it cannot digest it or absorb nutrients from it. The focus of eating and drinking should be for comfort and pleasure. Small tastes of their favourite foods and drinks may be what they want. Speak to their loved ones about what they may enjoy if they cannot tell you themselves.
Soft, smooth food can often be easiest such as ice cream, yogurt or soup. Drinks can be offered in small sips from a cup or from a teaspoon.
Here are some of the things you may notice happening:
- Reduced appetite & weight loss
- More frequent refusal of food and fluids. This may be shown non-verbally, for example, turning their head away from a cup/spoon, clamping mouth shut.
- Increased dependence on others to feed them
- Falling asleep during feeding
- Holding food and fluid in the mouth for a long time. It may take a long time to swallow
- Pouching food in the cheeks rather than swallowing
- Spitting out food and fluids
- Coughing during or following food and fluids
Useful Advice:
Conscious Level
No one should be given food or drink if unconscious or semi conscious. If your resident is no longer alert enough to manage oral intake, please discuss with their GP on whether the focus should now be on maintaining oral cares to maximise comfort.
Positioning
Position the patient upright in bed as near to 90 degrees as possible and ensure that their head is well supported with pillows, so it is not tilted backwards.
Ideally, keep them in this position for 30-60 minutes after meals and drinks to reduce the risk of reflux.
Food
The priority should be on comfort and quality of life, and they should be supported to have their favourite foods where these do not cause discomfort or distress. Softer or smooth foods are likely to be easier to manage. You can find ideas in our diet leaflets on our websites. (insert link) These vary from a level 3 liquidised diet to level 7 easy to chew consistency. Your resident may benefit from having the food well mashed or chopped up and served with extra sauce to make foods moist.
Drinks
Drinks should be offered in small sips or via a teaspoon. Try different cups to see what is more beneficial. Spouted cups and straws can sometimes be more problematic. Thickener is not routinely considered at end of life unless thin drinks are causing the patient significant distress, and they can clearly manage thicker textures more comfortably. You may find naturally thicker drinks like milkshakes or smoothies are easier to manage and a suitable alternative.
Oral Care
Maintaining regular oral cares are important to maintain comfort and reduce risk of infections like oral thrush. Ensure that mouth is clean and clear after all food. Please see our leaflet on maintaining oral care for people with swallowing difficulties. (insert link)
Offering regular sips of fluid will help prevent their mouth becoming dry. Where someone is no longer able to eat and drink, continuing with regular oral cares are important. In addition to toothbrushing as mentioned.
- Every 2-3 hours wet the mouth with a small, soft toothbrush using clean water
- If dry, apply a water based moisturiser such as Biotene oral balance saliva replacement gel or Oralieve moisturing mouth gel to their lips and inside of their mouth to keep their mouth moist. You can ask their GP to prescribe this.
