INTRODUCTION
Concerns about weight loss are commonly expressed by patients and their families/caregivers. Although decreased oral intake of food and fluids can occur at different times during the disease process and is a very common occurrence at the end of life, the resulting weight loss can be distressing to patients and caregivers alike. This can lead to the unpleasant assumption that the patient will become dehydrated or starve to death.
NUTRITION NEAR THE END-OF-LIFE
It is important to understand that loss of appetite near the end of life is a common occurrence and is often not as distressing to the patient as to family or friends. At this stage of life, most patients are not hungry, and food may be no longer appealing. Forcing nutritional intake can lead to decreased comfort. Decreased fluid intake also occurs naturally as a part of the dying process and is often not associated with thirst or discomfort. Additionally, if the patient develops swallowing difficulties, liquid can increase the risk of aspiration pneumonia, choking, and discomfort. IV fluids can worsen swelling complications, fluid accumulation, and lung congestion while not contributing to comfort or longevity.
INCREASING COMFORT AT THE END-OF-LIFE
Oral Hygiene
Moisten and clean the mouth with a swab as needed using plain water or a baking soda wash (1 tsp salt, 1 tsp baking soda, 1 qt tepid water). Avoid commercial mouthwash as most contain alcohol and can be irritating
Management of Oral Thrush
Swab or rinse using a nystatin liquid; consider a fluconazole tablet if the patient can swallow
Lip and Oral Care
Coat lips and nostrils with a thin layer of petroleum jelly or a similar formulation of lip balm to prevent drying
Eye Care
If the eyelids are not closed, moisten with lubricating eye gel, artificial tears, or saline solution