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Knowledge Point Articles   

August 2006

Nutrition and the Terminally Ill

As a mother, the first thing I thought of when my family was sick was chicken soup. “It’s good for what ails you,” I thought, as my own mother did. As a hospice nurse, many of the caregivers for terminally ill patients feel the same way. Food is the universal symbol of nurturing and love, so it is very difficult for family members see loved ones lacking the desire to try or the ability to eat. Many caregivers want to try anything when this happens. Some try supplements like Ensure or Boost, tube feedings or even intravenous (IV) nutrition.

There are published studies that show by forcing nutrition in terminally ill patients it is now of questionable benefit and often may actually worsen a loved ones condition, such as increasing tumor growth which could shorten life expectancy. Force feeding with oral supplements may cause gastrointestinal distress, thus increasing suffering. IV therapy can cause infection. Weight gain that may be seen by any of these modalities is usually attributed to fluid retention, not nutritional gain.

For family members, the realization that their loved one is dying becomes “real” when the loved one is disinterested in food. So they think if he or she eats, it will prolong life. It is difficult for family members to understand that by putting pressure on their loved one and attempting to force consumption, they are not prolonging life and may actually increase suffering. 

This doesn’t mean there aren’t things you can try when the appetite starts to decrease. Having smaller, more frequent meals may aide in digestion and be better tolerated. If you want to try supplements to boost intake, homemade ones like puddings, milkshakes, gravies and soups are often better tolerated. If your patients are able to handle hard candy, this may help with dry mouth that is often annoying and bothersome to the patient. If your patient would like to eat, but fear or nausea or vomiting hinders the appetite, there are many medications to assist with controlling this.       

Despite all methods of intervention, there may come a time when patients  just don't want to eat or are actually disgusted at the thought of consuming food. Family members have to understand their loved ones should not be pressured or forced into eating. The caregiver needs reassurance that it is acceptable and not cruel or negligent to cease force-feeding. Afterall, the only thing that matters is the patient’s best interest.

The topic of nutrition is probably one of the most frustrating, guilt ridden and emotionally charged issues that terminally ill patients and their families deal with.  But through proper teaching, emotional support and care, both families and patients can make decisions that will allow patients to live and die as comfortably as possible.

Cyndi Rohret RN, BSN, CHPN, CRNI
Clinical Consultant, Briggs Corporation

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