Why do people stop eating and drinking at end of life? Are they hungry? Are they thirsty? Are they suffering? These are important questions, especially for family members and caregivers watching someone they love approach the final stages of life.
In Episode 26 of The Geriatric Dietitian Podcast, we’re continuing our five-part series on nutrition at end of life by discussing what happens inside the body as someone prepares for death.
In our previous episode, we talked about the food fight and how changes in eating can create anxiety and guilt for caregivers. Now I want to explain the physiology behind these changes.
This episode is based on my article, End of Life Nutrition: What Everyone Needs to Know.
Why People Stop Eating and Drinking at End of Life
As someone approaches the very end of life, their body begins to change. Eating and drinking often decrease as part of this process.
For caregivers, it can be difficult to understand why someone who previously enjoyed food is no longer interested in eating or drinking. But the body’s needs and ability to process nutrition are changing.
Understanding these changes can help explain why encouraging someone to eat more isn’t necessarily going to improve their strength, comfort, or length of life during the final stages of dying.
Anabolic vs Catabolic Metabolism
One of the concepts I discuss in this episode is the difference between anabolic and catabolic metabolism.
During much of our lives, the body uses nutrients to build, maintain, and repair tissues. Anabolic processes involve building and storing energy. Catabolic processes involve breaking down stored materials to provide energy.
As someone approaches the very end of life, the body undergoes significant metabolic changes. Rather than using nutrition in the same way it did earlier in life, the body increasingly breaks down its own energy stores.
This helps explain why traditional nutrition approaches may no longer have the same effects during active dying.
What Happens When the Body Stops Receiving Food?
When someone stops eating, the body begins using stored energy.
In this episode, I explain how the body draws on its energy reserves and how ketones can be produced as part of this process. We also discuss the relationship between these metabolic changes, hunger, and comfort.
This is important because caregivers may assume that someone who isn’t eating must be experiencing the same hunger or discomfort that a healthy person would experience if they suddenly stopped eating. But these are very different circumstances.
The physiological changes occurring during the dying process affect how the body responds to food and energy intake.
Does Starvation Cause Suffering at End of Life?
One of the most emotionally difficult concerns for families is the fear that their loved one is starving to death.
In this episode, I discuss why reduced eating during the final stages of life is different from withholding food from an otherwise healthy person. When someone is actively dying, their body is already undergoing changes associated with the dying process. Declining intake is generally part of those changes rather than simply the cause of death.
Understanding this distinction can help families feel less fearful and guilty when their loved one no longer wants to eat.
Dehydration and Thirst at End of Life
Food isn’t the only concern for caregivers. Many families also worry about their loved one no longer drinking fluids.
In this episode, I discuss dehydration, thirst, and the role of hydration during the dying process. We talk about why dry mouth doesn’t always mean that someone needs more fluids and why providing mouth care can be an important comfort measure.
I also discuss questions surrounding artificial hydration and why additional fluids are not always beneficial during the final stages of life.
Decisions about hydration should take into account the individual’s condition, symptoms, and goals of care.
How Long Can Someone Live Without Eating or Drinking?
Another important question is how much time someone has left once they stop eating and drinking. Unfortunately, there isn’t an exact answer.
In this episode, I discuss how survival varies and reference research involving nursing home residents with dementia following the withdrawal of artificial nutrition and hydration.
These findings help illustrate that when someone is near the end of life and no longer receiving food or fluids, the time remaining may be short. However, every individual’s circumstances are different.
Understanding the Dying Process
I hope that understanding why people stop eating and drinking at end of life helps make this difficult process a little less frightening.
When we understand that the body changes as someone approaches death, we can begin to shift our thinking away from traditional nutrition goals. The focus becomes understanding what the person is experiencing and supporting their comfort.
In our next episode, we’re going to discuss common nutrition-related symptoms at end of life and strategies that may help manage them.
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