Nutrition and Hydration

Reduced oral intake is part of the dying process. This can be an emotive topic and should be discussed routinely with patients (where possible) and their families.

Simple measures to support nutrition and hydration when someone is dying

When a person is able to eat and drink, they should always be supported to do so as they desire. When someone is dying, the purpose of nutrition and hydration should be patient comfort and enjoyment. If the person has swallowing problems, discuss the benefits and risks of continuing to eat and drink. When someone only has a short time to live it may still be appropriate for them to eat and drink even if there is a risk of aspiration. • Refer to Eating and Drinking with Risk of Aspiration information leaflet.

All patients should be offered frequent mouth care. Consider using a patient’s preferred drink in place of water during mouth care.

Oral thrush is common – assess all patients and treat as necessary.

Thirst or dry mouth can also be relieved by simple measures such as:

• Sucking on ice lollies or small chips of ice • Assistance with brushing teeth or cleaning dentures • Application of lip balm

Clinically assisted hydration for dying patients

Clinically assisted hydration, for example intravenous or subcutaneous fluids, may be of benefit for patients who are dying but whose condition is deteriorating slowly, or for those who are experiencing: • Thirst not manageable by oral measures • Nausea and vomiting • Confusion and restlessness due to delirium

There are some risks associated with clinically assisted hydration in the last days of life, which must be balanced against potential benefits:

• Increased pulmonary or peripheral oedema • Increased chest secretions • Increased frequency of urination, which may be distressing for some patients. • Local discomfort from insertion of intravenous cannulas or subcutaneous infusions.

There is no clear evidence that either providing or withholding clinically assisted hydration has any effect on how long a patient will live.

The decision to trial clinically assisted hydration in a dying patient must be individualised to the patient’s circumstances. Trials should be reviewed every 12 hours to assess for benefits and adverse effects.

Patients who wish to die at home and require clinically assisted hydration can be supported with subcutaneous fluids in the community. For further details please see NICE Guidance NG31 – Care of dying adults in the last days of life.