I am commonly asked questions surrounding hospice care and how long can a hospice patient live without food and water? I wish I could give an exact end of life timeline. But it is not quite that simple. The human body is so different from one to another.
But we do have some time estimates that the answer is anywhere from days up to 3 weeks approximately someone can live without food and water!
You can also find our archive on articles written about end of life care for more info on the decreasing food and water intake during the dying process by clicking here.
What is Hospice Care and The Role of Hospice Providers
Hospice care is medical care that is given by health care providers to ill patients who are in the normal dying process.
The Hospice Team’s Goal is to:
Monitor a combination of signs that indicate someone is in the last months and last days of their life
Provide medical treatment to make the patient as comfortable and pain free as possible
Support family during the difficult time
Do the best thing and honour the patient’s wishes on their peaceful death
Honour spiritual needs at the end of their life
What is the Dietitian’s role in Hospice Care?
Monitor symptoms of decreased intake
Monitor weight, and discontinue if family and/or hospice patient requests
Monitor for symptoms of dehydration
Ensure that safe feeding and swallowing techniques are being followed
Ensure the hospice patient continues to be offered full meals and drinks if they want
Document changes that occur
Family counselling surrounding nutrition changes and what is expected
For nutrition counselling guidelines surrounding end of life, click here.
A person will be considered on hospice due to an age related decline, in other words, no specific illness, simply their age. This is what we would consider a normal dying process people. Or it can be related to a terminal illness that is the cause of death. This would be considered a terminally ill person. This can be a cancer patients, heart disease related, pneumonia, etc.
Hospice care can be delivered in a hospital bed, home care, long term care facility or nursing home.
Hospice doesn’t mean that a patient needs to be transferred to a special facility. A patient can die peacefully in their current long term care home.
At times a hospice agencies or a hospice nurse may be employed to visit the patient on a scheduled basis to check in, but this isn’t always welcome by the family members. It is a much better dying experience if the family and dying people if they can continue to be cared for my people they know and trust.
For this reason, typical in long term care is the staff there will continue hospice care.
Something people frequently get confused about is the difference between hospice care and palliative care. Palliative care precedes hospice care. Someone can be on palliative care for 20 years, whereas hospice care means death is imminent.
If you want to know more about the differences, click to read.
End of life doesn’t mean end of care, it means a shift to comfort care measures by the healthcare provider.
For the Dietitian, this means if the patient has a wound, they will continue to implement nutrition interventions such as supplements to aid in wound healing.
Importance of Discussing End-of-Life Care Options
End of life care needs to be discussed early on!
A patient’s typical life expectancy is 6 months or less, this gives hospice staff 6 months to discuss the dying wishes of the patient.
One of the key areas that needs to be discussed early on is the expectations surrounding artificial nutrition also called tube feeding at the end of life.
I will further discuss tube feeding and end of life below, so keep reading!
If a person is able to vocalise their wishes, that is the best case scenario. At the end of life emotions are obviously quite high for family members, and it is not always easy to approach tough subjects surrounding end of life decisions.
So be sure that family members are always kept up to date on the changes that are occurring, and honour where they’re at emotionally. Meaning if they aren’t ready to talk, don’t try to force them!
But do try to approach them what is expected at end of life before the time comes.
So How Long Can One Live Without Food and Water in Hospice Care?
First we need to understand the dying process to fully understand how long one can live without food and water in the hospice care area.
Common Signs and Symptoms of Final Stages of Life
It is important for healthcare workers to be familiar with the normal dying process, not only so they know what to expect when providing direct care to patients during this time, but also so they can guide the family in understanding what to expect during this process and providing support as needed.
Every dying person will experience the process in different ways, but the following is how we frequently see the pattern of death follow.
Loss of mobility and becoming bed bound; loss of interest or ability to drink and eat; cognitive changes to include increased time sleeping or experiencing delirium. Delirium can be a hyperactive or agitated state or a hypoactive state. The trademark point of delirium is there is an acute change in the level of arousal.
Further decline in mental status to becoming obtunded or slow arousal with stimulation and only brief periods of wakefulness. Patients often exhibit the “death rattle” which is a noisy breathing pattern caused by a pooling of oral secretions due to the loss of the swallowing reflex.
Final Phase of the Dying Process:
These are the signs of last days of life, patients are considered to be active dying with these symptoms. Coma; fever, possibly due to aspiration pneumonia; an altered respiratory pattern which can be periods of apnea alternated with hyperpnea or irregular breathing; and mottled extremities due to the constriction of the peripheral circulation
The timeline for each patient is variable. A patient may experience these signs and symptoms over 24 hours or for longer than 14 days.
Importance of Symptom Management in Hospice Care
Pain management is one of the most important things to comfort a person and loved ones at the end of life.
Hospice care needs to closely monitor the patient’s verbal and nonverbal expressions of pain. If you want to know more about this, read this article.
This is not a duty for the nutrition care of a patient, but it can be noted by the Dietitian and discussed with the healthcare team. Though pain management isn’t the responsibility of the Dietitian, there are MANY nutrition symptoms to identify and monitor.
The Role of Nutrition and Hydration in Hospice Care
I’ve talked in previous articles about the importance of a Dietitian in hospice care.
But we cannot emphasise enough that the Dietitian can play a pivotal role in educating people and their loved ones on the role of nutrition in end of life care. Providing education early and often to the patient and family about what is to be expected can provide a sense of peace during the process.
The Purpose of Providing Nutrition and Hydration in Hospice Care
Hospice care means shifting care to a comfort feeding approach.
There are some frequent nutrition related symptoms that occur as a result of end of life care, this includes:
Weight loss
Malnutrition
Dry mouth
General weakness
Fatigue and less energy
Food intake decreases
Lack of appetite or total loss of appetite
Low sense of hunger
Decreased use of solid foods
Taking only small sips of water
Eating smaller portions
Activity level significantly decreases
Digestive system slows down significantly
The ability to process food becomes difficult as evidenced by increased bloating, gas, discomfort complaints which is why typically portions of intake become smaller and smaller.
Symptoms will be individual at the end of their lives, but we see a significant amount of these in the hospice patient.
How to Manage Hospice Care Nutrition Symptoms:
Favorite foods and drinks may not always fit into what is safe within the nutrition care plan guidelines. But at the end of life, diet liberalisation should be encouraged as much as possible as a general rule. Food for most of our lives is an expression of love, so focusing on what someone enjoys conveys this.
This translates to:
Liberalising diet textures as safe as possible
Cancelling controlled carbohydrate diet restrictions
Providing favourite foods and drinks
Not pressuring a person to eat or drink if they are refusing
Discussing artificial nutrition with the patient and/or loved ones
The Benefits and Risks of Providing Artificial Nutrition and Hydration
Artificial nutrition in hospice care can be a very difficult topic to address. At the end of the day though, the Dietitian’s job is to provide the information and the person or loved ones makes the final decision.
Here are some pros and cons
It is ultimately up to the patient and their family members to decide on tube feeding, but it helps if the Dietitian can have a discussion as to why they want it.
If dehydration and starvation are significant concerns, then the Dietitian can offer alternative approaches to managing the symptoms.
Many family members will begin to ask the questions, without tube feeding, how long can one live without food and water? While we have discussed that it can be a few days to weeks. Implementing tube feeding will not extend the amount of time someone lives.
It’s important that they understand this. So instead of implementing something with very little efficacy, we can look at what they can do instead.
Alternative Approaches to Managing Symptoms Related to Dehydration and Starvation
When a person stops eating or drinking, these are some methods that can both provide care, comfort, and relief from symptoms:
Providing mouth care
Ice chips
Moist toothettes
Applying lip balm
Encourage the family to shift the focus of meetings away from food to simply enjoying time together!
How Long Can One Live Without Food and Water in Hospice Care?
So finally, one of the most common concerns of patients and their families in hospice care is the length of time a person can live without food and water. It will vary by person, but some factors that will affect how long they survive are:
Overall health status
Any pre-existing medical conditions
Their level of hydration and nutrition prior to entering hospice care
Age
Gender
Presence of chronic diseases
These may all impact an elderly person’s ability to survive without food or water.
Additionally, a person’s mental and emotional state can play a significant role in their overall well-being during end-of-life care. Understanding these factors can help hospice caregivers provide the best possible care for their patients in their final days.
Estimates of Survival Times Without Food and Water
In general, it can range from as long as 3 weeks to a few days. Though typical survival time is only a few days.
If you want to read on the end of life stages timeline, you can read this article.
With the assistance of hospice care providers they can provide comfort measures and address any symptoms or discomfort the patient may experience during this time. Understanding the general timeline of what happens to the body when it is deprived of food and water can help patients and families better prepare for the end-of-life journey.
The Ethics of Withholding Food and Water in Hospice Care
The decision to withhold food and water during hospice care is a complex ethical issue that requires careful consideration of the patient’s wishes, values, and beliefs.
While providing nutrition and hydration can prolong life, it may not always be in the patient’s best interests to provide this artificially.
In some cases, it may even cause more harm than good, leading to discomfort, pain, and decreased quality of life. It is important to honor the patient’s autonomy and respect their right to make informed decisions about their end-of-life care.
While we can continue to offer food and water as long as the patient is accepting, when they begin to refuse or are no longer conscious to accept safely. It should be discontinued.
By prioritizing the patient’s comfort and well-being, hospice caregivers can ensure that they are providing compassionate and ethical care during this challenging time.
The Ethical Principles That Guide End-of-Life Decision Making
Ethical considerations are essential in ensuring that patients receive compassionate, holistic care that respects their values, beliefs, and wishes.
End-of-life care choices can be challenging because they involve difficult decisions about pain management and artificial nutrition and hydration
It is crucial for hospice caregivers to prioritise patient autonomy and ensure that patients and families are fully informed and involved in the decision-making process. By providing education, counselling, and emotional support, hospice teams can help patients and families navigate these difficult choices with compassion and respect.
Ultimately, ethical considerations are at the heart of hospice care, guiding every decision and ensuring that patients receive the best possible care during their final days.
Wrapping Up All Things Hospice Care
Exploring hospice care and the dying process is a complex topic and a significant area of education is how long one can live without food and water.
Hospice care is a specialised healthcare designed to provide comfort and support to individuals at the end of life. I hope from here you better understand the physiological changes that occur during the dying process and the common signs and symptoms of approaching death.
Nutrition and hydration should continue to be offered to a person as long as they are accepting. Liberalising diet textures, cancelling controlled carbohydrate diet restrictions, and providing favourite foods and drinks are recommended in end-of-life care.
The importance of discussing end-of-life care options early on to guide patients and their families especially in nutrition care should be done.
If you are a Dietitian and want to continue educating yourself specifically on end of life, hospice care clinical nutrition information. I recommend our amazing End of Life Nutrition guide.
This End of Life Nutrition Guide comes with an eBook to walk you step by step through decision making nutrition care, AND a video that will help teach you discussion points when talking to the healthcare team and family members!
Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.
