Nutrition and Hydration
The hospice view
In advanced illness, decreased intake is a natural part of dying. The body can no longer use food and fluid efficiently. Forcing food or fluids can cause harm - aspiration, edema, discomfort, and distress. The goal shifts to comfort: offering small amounts, moistening the mouth, and respecting refusal.
What the assistant does
- Offer small, frequent, high-calorie or preferred foods.
- Position upright for safety, allow time, and stop at signs of choking or fatigue.
- Provide mouth care frequently - it relieves thirst even without fluid intake.
- Honor cultural and religious food practices when possible.
Traps to watch
- Equating "not eating" with "giving up" or with suffering.
- Pushing food to reassure a worried family.
- Ignoring aspiration precautions or feeding a drowsy patient.
- Assuming thirst means the patient needs IV fluids - mouth care often addresses the discomfort.
Rule of thumb
Offer, do not force. Report intake and any choking, coughing, or difficulty swallowing.
Worked example: A daughter begs the assistant to "make Dad eat." The assistant validates her concern, explains gently that appetite naturally decreases and that mouth care keeps him comfortable, offers him a few spoons of his favorite pudding, and reports the family's distress to the nurse and social worker.