Part of my duties at FAIRHOPE Hospice and Palliative Care, the home of the Pickering House, is to talk to every civic and church group and every type of organization in the community about hospice care.
When I begin my talk I usually start by asking if anyone has questions about hospice. I know that sounds backwards but it is the only way for me to find out what they want to know regarding hospice.
It also helps me to learn if they have any misconceptions regarding hospice. If I may generalize, almost anyone who has not witnessed FAIRHOPE Hospice compassion first hand will have misconceptions.
At one presentation a man said that he felt guilty because while he was caring for his ailing mother she came to the point where she wouldn’t eat. She had been ill for quite some time and eventually became bedridden. As she continued to decline in health he had to feed her. It wasn’t that long before she refused to eat at all. His effort to feed her was repeated at mealtime for several days. According to him, she died within a week or so. He felt guilty because he couldn’t get her to eat and had, in effect, starved her.
Eating at the end of life is not a subject that I discuss too often at a presentation but his statement brought up the prevalent misconception that sometimes hospice may let a patient starve. I explained that a hospice patient differs in many ways from that of a healthy person.
Since food is necessary to sustain life the body knows that food is no longer necessary in the last stage of life and, therefore, rejects it. There is no more need for nutrition. The sensation of not wanting food is very similar to when you have an upset stomach and are not interested in eating.
The truth is, there are many normal activities that we have done all of our life that are no longer relevant at the end of life. During your last stage of life you are a different person. This is especially so with your physical qualities; your metabolism is different, your bodily functions are different, and your organs may begin the process of turning off. The same type of medical attention and care that you received through your life up to this point doesn’t work anymore.
In FAIRHOPE’s folder given to the family of someone signing on is an explanation detailing why certain food and liquids should be restricted or removed from a person’s intake. The information explains in detail why food is no longer needed, and in general, why many of the body’s normal functions have stopped and don’t need to be addressed any longer. Also, information as to why certain things that were a part of everyday living should or should not be done anymore are discussed. The following few paragraphs contain information taken from that new patient folder.
Sometimes your loved one will not want to eat and drink due to the body slowing down with fewer physical needs. The person does not need calories to convert to energy anymore. As death approaches, dehydration occurs naturally from not enough food or liquid intake. Occasional thirst, dry mouth, and changes in mental status sometimes happen. The mental changes, while upsetting to you, bring relief to your loved one by lessening their awareness of suffering.
The administration of IV fluids may produce a feeling of well-being, but it’s usually a fleeting sensation. In time, artificial hydration is likely to heighten the discomfort of a terminally ill patient and often increases underlying symptoms. Reducing fluid intake decreases lung congestion and coughs.
Unless kidney function has declined, IV fluids increase urine output, often creating a need for an indwelling catheter. Fluid deprivation eliminates the frequent use of a urinal or bedpan and the discomfort that goes along with it. IVs can contribute to increased chances of developing pressure sores, swelling, and can also cause increased pressure on tumors, organs and nerves causing increased pain. Dehydration diminishes the risk.
Mouth discomfort, then, is dehydration’s only drawback, Good mouth care and comfort measures bring relief. To ease a patient’s mouth discomfort, use moisturizers and frequent rinses with nonalcoholic mouthwashes. You may also offer ice chips and the patient’s favorite liquid frequently. Apply lip balm or petroleum jelly to chapped, dry lips but avoid lemon and glycerin swabs because they promote dryness. Accompanied by comfort measures and emotional support, dehydration is a humane therapeutic response to terminal illness.
As we all know, there are no absolutes in life except death, and taxes. So to backtrack just a bit, depending upon the patient’s progress in the last stage of life there are foods and fluids that can be given to a patient that are comforting. When relevant, adequate nutrition while on FAIRHOPE care is important. The patient will let you know when enough is enough. It is extremely hard on those close to the person to restrict intake, but your loved one knows when their Hour is approaching.
Offer foods, or snacks that are a favorite of the patient. Sometimes cold foods such as ice cream or a fruit flavored slushy may help. Try offering frequent, small meals and maybe take a break while eating. Hard candy or chewing gum may help to keep the mouth moist as will rinsing the mouth frequently.
So much of what FAIRHOPE suggests for a patient may not seem logical at first, especially when it comes to eating. However, a person in the last stage of life is different, both physically and emotionally, from when they were healthy. It is important to know that everything we do for your loved, you and your family is driven by our desire to give comfort.
Should you have any questions about call us. We are FAIRHOPE Hospice and Palliative Care and the home of the Pickering House. Our purpose is to comfort.
Written and submitted by Rick Schneider of FAIRHOPE Hospice.
Author Rick Schneider
