Hospice care often requires difficult conversations and choices made by doctors, patients, and their loved ones. Artificial nutrition and hydration (ANH) at the end of life, whether it be the decision to begin, continue, or discontinue it, is delicate.
Multiple medical guidelines and ethical issues, patient and family emotions, difficult questions about withholding food and water at the end of life, and religious, cultural, spiritual, and personal influences surrounding a loved one’s impending death all contribute to the difficulty of such decisions.
By drawing on their substantial medical-clinical expertise and being guided by empathy, healthcare personnel may be able to negotiate these challenges.
Developing a Tailored Hospice Care Strategy
When a patient’s preferences and values are unclear, advance care planning is the best way to clarify them before they cannot express themselves. The primary purpose of ANH is to educate clinicians, patients, and their families about death and dying. The hospice care team can be a great asset in facilitating such conversations, ensuring that all relevant medical, ethical, and professional considerations are considered.
Decisions about ANH should always be made after a thorough, honest, and comprehensive conversation addressing the patient’s condition, goals of care, and needs.
Detailed analysis of the patient’s condition and outlook: Is there a connection between what you eat and how you feel?
In what circumstances should ANH not be used, and when should it be used?
Is there any information available on the patient’s or their family’s personal, cultural, or religious beliefs? How may their preferences be incorporated into the hospice’s care plan?
When it comes to human suffering, will mechanical feeding and hydration make things worse or better?
Will the patient’s wishes and values be considered in all care decisions?
Tell loved ones you’re dying.
The evidence does not support the claim that denying a dying person food and water reduces their suffering and extends their life. Care goals and the final hospice care plan should be discussed in light of such evidence. The hospice care plan should change as the patient’s health status does.
Assuring families that hospice patients who stop eating or drinking are not “given up” or “starving” is another meaningful way for doctors and nurses to ease the minds of worried loved ones. Instead, doctors should tell dying patients and their loved ones that their bodies will stop digesting and eventually be unable to process meals and fluids as part of the natural dying process. The release of “feel-good” endorphins by the body as natural pain therapy is something that families of terminally ill patients may find comforting.
What are the Benefits of Tube Placement, and What are the Risks and Complications of Doing So?
Instructions for Hospice Patients Regarding the Use of Feeding Tubes
Whether a patient is admitted to hospice with an existing feeding tube, doctors should work closely with the patient, family, and caregivers to decide if and when ANH should be reduced or stopped. Rather than prolonging life, ANH near the end of life may cause more distress, aspiration, and pressure sores.
A feeding tube is rarely placed if a patient has already entered hospice care. Patients, families, and hospice care teams collaborate to decide when a feeding tube should be inserted.
Studies show that ANH does not extend or increase life expectancy, but it is linked to some issues that lower the quality of life for patients. Aspiration pneumonia, bleeding, reflux, uncontrolled diarrhea, limited socialization/movement, frequent tube replacement/removal, inadequate dental care, and growing physical and pharmaceutical constraints are all common dangers associated with tube feedings. Symptoms of “drowning” or uncomfortable fullness are another side effect of terminal tube feeding.
Enteral tube feeding for people with severe dementia
An illustration of diagnosis-specific guidelines would be the recommendation that feeding tubes not be used for patients with severe Alzheimer’s disease or dementia by the American Geriatrics Society, the American Academy of Hospice and Palliative Medicine, and the Society for Post-Acute and Long-Term Care Medicine. It is advised that you switch to an oral-assisted feeding method instead.
Seeing a loved one slowly die from a terminal illness is one of life’s most difficult experiences. The discovery that a family member has stopped eating and drinking compounds an already challenging situation.
Since many cultures and families have long used food and drink to show their love and appreciation for one another, they worry that they are insensitive if they don’t provide for their loved ones. They may fear that you’ve given up on them.
That is not even close to the truth. In other words, it’s a standard component of passing away. Less food and water are necessary for a person than for an active, healthy human.
No patient in hospice is ever refused food or drink. No one can stop someone from eating or drinking if that person so chooses. Most patients, however, eventually reach a point when they care less about eating and drinking and can go for extended periods without doing so.
Alterations in Physical State during Palliative Care
People’s digestion and absorption abilities decline as they get closer to death. Organs and physiological processes start to shut down, and limited nutrition or hydration is required, if any.
It can be upsetting to insist that your loved one receives food and water, especially if they need to be artificially fed or hydrated through a nasal or stomach tube. Forcing someone to eat or drink might cause more suffering and health problems.
The hands, feet, and lower extremities may swell as the body loses its capacity to regulate fluid. In the worst cases, it can lead to pulmonary edema, which prevents the lungs from expanding enough to deliver enough oxygen to the blood and causes symptoms such as shortness of breath and coughing. Hypoxia describes this condition. Disorientation, anxiety, and even aggressiveness have been linked to low oxygen levels.
Feeding a loved one at the end of life can have its challenges. Chocking or aspiration can occur if food is pushed into the mouth against the person’s will. A terrifying illness known as aspiration happens when food or liquids enter the lungs. A dry cough and shortness of breath are two of the symptoms it can bring on. Other possible side effects include nausea, vomiting, stomach bleeding, bloating, constipation, or diarrhea.
The dying individual may find all of these to be quite upsetting. A healthy individual may see these symptoms as annoying, but a dying person finds them intolerable.
Contrary to popular belief, food and drink may not be used as a form of consolation and affection at the end of life. How, therefore, may we show our gratitude and ensure the ease of those closest to us?
What You Can Do to Help a Hospice Patient’s Loved One
The best thing you can do for a loved one at the end of their life is to be there for them emotionally and psychologically.
If they can swallow, give them small amounts of food and liquid, such as ice chips, a few bites of food on a spoon, or a piece of hard candy. Listen to them if a loved one tells you they’ve had enough.
After a person has stopped drinking, you can keep their lips and mouth moist with cotton swabs, lip balm, or a wet washcloth. Your loved one’s mouth can be kept moist with a special swab with a sponge tip, delivered to them by the hospice staff regularly.
Provide alternative methods of comfort, such as discussion, music, singing, reading, pet visits, gentle massage, spiritual or religious rituals, and other acts of love if your loved one cannot eat or no longer desires food. For more information visit our website.
Hospice care providers should be consulted.
If you’re worried about your loved one’s lack of appetite or thirst, talk to the hospice staff. They can explain what’s happening to your loved one’s body as it passes away. They can give you more advice on making your loved one comfortable as a sign of your affection for them. Get in touch if you have any questions regarding our hospice care or if you’re considering having us transport your loved one.
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