Questions from the bedside “are they starving?”
“Are they starving?” It’s one of the questions I hear most often. Someone you love has stopped eating. Maybe they’re taking only a few bites a day. Maybe they’re no longer asking for their favorite foods. Eventually, they may stop eating altogether. And for the people who love them, this can be incredibly difficult to watch.
Food is care. Food is comfort. We bring soup when someone is sick. We make favorite meals for the people we love. We celebrate with food, gather around it, and use it to nurture one another throughout our lives. So when someone we love stops eating, every instinct in us can say: They need to eat. But at the end of life, something different is happening. They are not starving in the way we think of starvation. As the body begins the natural process of dying, it requires less and less energy. The digestive system slows. Hunger and thirst often diminish. Eventually, the body may no longer be able to process food and fluids the way it once did.
The person isn't necessarily refusing food because they've “given up.” Their body is changing, and their desire and ability to eat often change with it. When someone is in the natural dying process: they aren't dying because they aren't eating. They aren't eating because their body is dying. That can be incredibly hard to trust when you're standing beside someone you love.
“But shouldn't we try to get something into them?” If someone is awake, interested in food, and able to swallow safely, absolutely offer what sounds good. At this stage, though, eating is usually about pleasure and comfort rather than calories. A spoonful of ice cream. A sip of juice. A little applesauce. A favorite flavor. We will go out of our way to get patients their favorites: an Italian sub on a bulkie, pink champagne, a McDonald’s cheeseburger, a grilled hot dog, even if only for a bite or a sip. There doesn't need to be a nutritional goal attached to it.
And when someone no longer wants food, encouraging or forcing them to eat can sometimes cause more discomfort rather than less. As swallowing becomes more difficult, food and fluids can lead to coughing, choking, aspiration, nausea, or simply the discomfort of asking a body to do something it is no longer equipped to do. Following the person's cues becomes more important than finishing a meal.
If you find yourself wondering, Are they starving?, ask the hospice nurse or medical team what they're seeing. Every person's situation is different, and sudden changes in appetite can have causes other than the dying process. But when someone is approaching the end of life, a decreasing appetite is often a natural part of the body's slowing down. Your job isn't to convince their body to keep doing something it is naturally letting go of. Your job can simply be to follow their lead, keep them comfortable, and love them through it.
“What about water?” This is another question I hear all the time. Families understandably worry that their loved one must be terribly thirsty. But as the body slows, the sensation of thirst also changes. Often, mouth dryness is a major source of discomfort. And that is something we can help with. Mouth swabs, small sips or ice chips when safe, lip balm, and gentle mouth care can provide tremendous comfort. Families sometimes ask about IV fluids, too. In the final days of life, the body may have difficulty handling extra fluid, which can build up and cause swelling or make breathing more difficult. IV fluids may help in some situations, but they don’t automatically make someone more comfortable. The hospice or medical team can help weigh the potential benefits and burdens for that person. We can continue offering drinks when someone wants them and can swallow safely, without pressuring them to drink more.
“If I'm not feeding them, what am I supposed to do?” This may be the hardest part. Because feeding someone feels like doing something. When you can no longer fix what is happening, offering another bite or another sip can feel like one of the last ways you know how to care for them. But care doesn't disappear when eating stops. You can moisten their mouth. You can put lotion on their hands. You can adjust their blanket. You can play their favorite music. You can sit beside them. You can tell stories. You can say the things you want them to hear. You can simply be there. Sometimes the smallest acts become the most meaningful ones.
And please know, if you’ve done this before: encouraged another bite, worried they weren’t getting enough, tried to convince them to eat, pushed for more nutritional support… that’s okay. You were caring for someone you love.
This is part of why I feel so strongly about community education around death and dying. We rarely talk about what a natural death looks like. How would you know unless someone explained it? And when that explanation comes in the middle of grief, fear, and decisions that need to be made right now, it can be incredibly difficult to take it all in. Even medical professionals aren’t always well versed in end-of-life care. We do better when we know better, and people deserve the chance to learn these things before they’re standing at someone’s bedside.
