Jessica said she was passionate about supporting people with their unique food and nutrition needs throughout their cancer journey, spanning from diagnosis through until end of life. She said that navigating the physical, social and emotional changes that come with transition to palliative care is incredibly challenging and that CarerHelp is a practical resource for carers during this time.

Eating and drinking towards the end of life

Supporting someone with their eating and drinking as they approach end of life can be a confusing and emotional space to navigate. Eating and drinking holds lots of physiological, emotional and social importance for many of us as we move through life, so how does this change when someone we are caring for nears the end of their life?

It can be very difficult to watch someone’s appetite reduce as they approach the end of their life. There may be times when the person you are caring for tells you they are hungry or thirsty, but they may not physically be able to manage food or drink.

However, it is important to remember reduced food intake and appetite is a natural part of the dying process. This happens as a person’s digestive system slows down, along with their other body systems. Many people approaching end of life will make it clear they don’t want to eat or don’t have an appetite. Sometimes people may miss meals because they are sleeping for long periods as their body becomes more tired. This is normal and OK. Too much food and drink can often cause a person to feel more uncomfortable as they approach end of life.

If the person you are caring for is wanting to eat and able to eat, offer them foods that they enjoy and tolerate in small amounts. Even if their favourite food or drink is less ‘nutritious’ or ‘healthy’ than normal recommendations, this is OK. When it comes to eating and drinking at end of life, our biggest goals are to promote comfort and quality of life, rather than to maximise nutritional intake.

If they cannot eat but are requesting food or drink, you may want to offer ‘taste for pleasure.’ First, ensure their mouth is clean. Then, dip a mouth sponge or soft toothbrush in their favourite flavour (this can be anything from chocolate ice cream, to custard, tea, coffee or even whiskey!). Shake off the excess, then apply to their lips and/or tongue so they can taste the flavour.

Regular mouth care is important to keep the mouth moist and comfortable

As someone becomes less interested in eating and drinking at end of life, their mouth can become dry. If a dry mouth is not managed well, this can lead to other issues such as mouth sores, oral thrush, taste changes and difficulty speaking.

Keep the mouth moist by regularly offering sips of water or ice chips (if they can swallow), or regularly using a moistened mouth sponge to wet the inside of the mouth and lips. Use lip balm or moisturizer on the lips to keep them moist. There are dry mouth gels and sprays that can also be used to lubricate the mouth- speak to your doctor or nurse to see if these would be useful.

It is also important to try to keep the mouth clean. This video from St Vincent’s Hospital provides some tips on how to perform oral care.

https://www.svhs.org.au/our-services/list-of-services/palliative-care-resources/personal-hygeine/mouth-care

Carers play a crucial role in supporting a person’s nutrition when they are unwell. I frequently meet carers who do incredible work providing the right food and drink to meet specific nutritional requirements. However, when a person approaches end-of-life, goals around eating and drinking change. Carers still have a role to support eating and drinking at this stage, but the role just looks a little different.

Authors:

Jessica Jong, Clinical Dietitian, Peter MacCallum Cancer Centre