They've stopped eating and drinking. Are we starving or dehydrating them?
When someone is very close to death, stopping eating and drinking is usually part of the dying process.
When someone is very close to death, stopping eating and drinking is usually part of the dying process. In this situation, they are not usually dying because they are not eating or drinking. They are often not eating or drinking because their body is dying.
This can still feel deeply wrong to watch. Food and drink mean care, love and comfort in many families. The focus near death is usually comfort: mouth care, small sips or tastes if safe, and relief of symptoms rather than forcing intake.
General information: This page gives general information for people in Australia. It cannot tell you exactly what is happening in one person's situation. If you have concerns about a symptom, medicine, treatment decision or change in someone's condition, contact their doctor, palliative care team, nurse or other treating health professional.
Why appetite and thirst change
As the body slows down, it uses less energy. The stomach and gut slow. The person may feel full after a few mouthfuls, sleep through meals, or have no interest in food. Taste may change. Nausea, dry mouth, constipation, pain, medicines, infection, dementia, swallowing problems or fatigue can also affect eating and drinking.
Earlier in illness, some of these causes may be treatable. Near death, eating and drinking often reduce because the body can no longer use food and fluid in the usual way.
Many people near death do not feel hunger or thirst in the same way a well person would. Dry mouth is common and can be uncomfortable, but it is not the same as needing a full drink. Mouth care can help a lot.
Why forcing food or fluid can harm
Forcing food or drink can cause distress. If the person is too sleepy or weak to swallow, it can lead to coughing, choking, or food and fluid going into the lungs. A full stomach can also worsen nausea, vomiting, bloating or breathing discomfort.
If the person turns away, clamps their mouth, coughs, pockets food in their cheek, falls asleep with food in their mouth, or sounds wet after swallowing, stop and ask for advice.
What you can still do
You can still care for them through food and drink in safer ways.
If they are awake and can swallow, offer small amounts of what they like. This might be a sip of water, ice chip, spoon of yoghurt, jelly, custard, soup, tea, or a favourite taste. Let them decide whether to take it. Stop if they cough, become drowsy, turn away or seem uncomfortable.
If they cannot swallow safely, ask about mouth care. You may be able to moisten their mouth with a swab, apply lip balm, or offer taste for comfort in a way the nurse or speech pathologist says is safe.
Sitting with them, holding their hand, playing quiet familiar music, praying, reading, or keeping the room calm can be care too. Feeding is not the only way to show love.
Ask whether anything treatable is going on
A sudden drop in eating or drinking should be discussed with the team, especially if death is not clearly close. Ask whether there may be pain, mouth ulcers, ill-fitting dentures, constipation, nausea, infection, confusion, depression, medicine side effects, or swallowing problems.
A dietitian or speech pathologist may help earlier in palliative care. In the last days, their advice may focus more on comfort and safety than nutrition targets.
When to get help now
Contact the palliative care team, GP, nurse or aged care staff if the person is coughing or choking with food or drink, has a wet or gurgly voice after swallowing, seems hungry or thirsty but cannot manage food or fluid, has a sore mouth, repeated vomiting, distress, or a sudden change that has not been explained.
Call 000 if the person is choking and cannot breathe, or if there is a sudden life-threatening emergency and no end-of-life plan. If the person is expected to die and has a written care plan, follow that plan and contact the listed service.
You may also want to read
- Should I make someone who is dying eat?
- Would IV fluids help someone who is dying?
- Would a feeding tube make someone stronger near the end of life?
- How do I know if someone who cannot speak still wants food or drink?