Hospice care necessitates painful talks and decisions between healthcare providers, patients, and families. Initiating, sustaining, or removing artificial nutrition and hydration (ANH) as a patient nears death is one of the most difficult topics.
Such decisions are complicated by multiple medical guidelines and ethical issues, patients’ and families’ emotions, their difficult questions regarding withholding food and water at the end of life, and the religious, cultural, spiritual, and personal influences surrounding a loved one’s impending death.
Healthcare workers may negotiate these challenging issues by engaging in dialogues informed by their extensive medical-clinical knowledge and guided by empathy.
Create a Personalized Hospice Care Plan
Advance care planning is the optimal method for elucidating a patient’s wishes and values before the patient’s incapacity to communicate them. Clinicians can educate patients and their families about natural death, mainly the function of ANH. So that medical, ethical, and professional standards are met, the hospice care team can be an invaluable resource for facilitating such dialogues.
Because each patient’s condition, goals of care, and needs are unique decisions regarding ANH should always be made following a careful, forthright, and informative conversation addressing:
- Specific diagnosis and prognosis for the patient: How do nutrition and hydration impact both?
- What are the indications for or contraindications against ANH?
- What are the patient’s and their family’s personal, cultural, and religious views and values? How may their wishes be respected within the hospice care plan?
- Will artificial feeding and hydration increase or alleviate human suffering?
- Will care-related decisions respect the patient’s preferences and values?
Inform relatives about the dying process
Current research does not support the claim that withholding food and drink at the end of life increases misery and lengthens life. Such evidence should be incorporated into discussions about care goals and creating a customized hospice care plan. As the patient’s condition evolves, so should the hospice care plan.
Doctors and nurses must also address emotional concerns by assuring families. That hospice patients who stop eating or drinking are not “given up” or “starving.” Instead, professionals should inform patients and families about the body’s natural dying process, which involves the cessation of digestion and an increasing inability to process food and fluids. Families might take comfort in that, when a patient’s food and fluid intake decreases, the body frequently releases “feel-good” endorphins as a natural pain treatment.
Tube Placement: Advantages against Dangers/Complications?
General feeding tube instructions for hospice patients:
Existing feeding tube: If patients are admitted to hospice with feeding tubes in situ, doctors should collaborate closely with patients, families, and caregivers to determine if and when ANH should be decreased or discontinued. As the End Of Life Care In San Francisco approaches, ANH may contribute to discomfort, aspiration, and the development of pressure sores without extending longevity.
Once a patient is engaged in hospice care, feeding tubes are often not inserted. In rare cases, a feeding tube placement choice is made in collaboration with the patient, family, and hospice interdisciplinary team.
In general, studies indicate that ANH does not improve or prolong life. But it is associated with several problems that reduce the patient’s quality of life. Common risks include irritation, infection, blockage, discomfort, aspiration pneumonia, bleeding, reflux, uncontrolled diarrhea, limited socialization/movement, frequent tube replacement/removal, insufficient dental care, and increasing physical and/or pharmacological restraints. End-of-life tube feeding can also cause patients to feel “drowning” or unpleasant fullness.
The American Geriatric Society, American Academy of Hospice and Palliative Medicine, and The Society for Post-Acute and Long-Term Care Medicine do not suggest feeding tubes for patients with severe Alzheimer’s/dementia as an example of diagnosis-dependent guidelines. Oral aided feeding is recommended instead.
Few things are more complex than witnessing a loved one with a terminal disease fade away. When families discover that a loved one has ceased eating and drinking, the situation becomes even more difficult.
They question if they are being careless or hurtful by not ensuring their loved one has food and drink. As many family traditions use food and drink to express care and affection. They may feel as though they are abandoning them.
Not even remotely close to the truth. It is part of the natural dying process. Significantly less food and water are required for a person than for an active, healthy individual.
A hospice patient is not denied food or liquids. If some one desires to eat or drink, there are no constraints on their ability to do so. However, most patients reach a stage where they neither desire nor require food or water.
Changes in Physical Condition at the End of Life Care
As a person nears death, their ability to digest and assimilate food and liquids diminishes. Organs and body functions start to shut down, and limited nutrition or hydration is required if any.
Insisting that your loved one receives food and water. Even artificial nourishment or hydration through nasal or stomach feeding tubes can be distressing. Forcing food and water can result in further physical discomfort and complications.
As the body loses the ability to control fluid, the feet, legs, and hands may enlarge. Worse, it can cause pulmonary edema, resulting in shortness of breath, coughing, and an inability to oxygenate the blood adequately. This is referred to as hypoxia. Hypoxia can result in disorientation, anxiety, and even aggression.
At the end of a loved one’s life, feeding might provide a unique set of complications. Forcing food into the mouth might result in choking or aspiration. Aspiration occurs when food or liquids enter the lungs, and it is a harrowing condition. It can cause the same symptoms as liquids, including coughing and shortness of breath. In addition, it may cause nausea, vomiting, stomach hemorrhage, excessive gas, constipation, or diarrhea.
All of these can be very distressing for a dying person. These symptoms are unpleasant for a healthy person, but they are excruciating for a dying person.
At the end of life, food and drink may no longer be a means of providing comfort and expressing affection, despite the common perception. So, what can we do to express our appreciation and make our loved ones more comfortable?
How to Assist a Loved One with Hospice Care
At the end of life, the best thing you can do for a loved one is to provide support.
If they can still eat or drink, offer them little sips of water or drinks, ice chips, tiny spoonfuls of food, or hard candy. Follow your loved one’s lead when they have had enough.
If the individual has stopped drinking, moisten their lips and mouth using cotton swabs, lip balm, or a wet washcloth. Your hospice care team will frequently deliver a particular swab with a sponge tip to provide your loved one with mouth moisture.
If your loved one is unable to eat or no longer desires food. Provide alternative consolation methods, such as conversation, music, singing, reading, visits from pets, gentle massage, spiritual or religious rituals, and other acts of love.
Consult Your Hospice Care Group
Talk to your hospice care team if you feel scared and anxious about your loved one’s lack of interest in food and liquids. They can help you comprehend the dying process and the physical changes occurring in your loved one’s body. They can provide further tips for making your loved one feel at ease to demonstrate your affection. Contact us to learn more about our hospice care and why you should entrust us with the transfer of your loved one.