The nutrition and hydration of older adult cancer patients in hospice

Abstract

The use of artificial means of nutrition and hydration for terminally ill patients is a controversial topic, involving medical, legal, social, and ethical issues. Often, the patient who is dying in the hospital and ceases to eat and drink receives tube feeding. In contrast, hospice patients are usually not given tube feeding, and emphasis is placed on palliative treatment. The purpose of the first project was to describe the dietary intake of twelve older adult cancer patients in home hospice care. The mean daily intakes of energy for males ranged from 657 to 2142 kcal per day, or from 28 to 93% of the recommended intake (RI). For females, the mean daily intakes of energy ranged from 358 to 1852 kcal per day or from 18 to 97% of the RI. Intakes for protein, carbohydrate, fat, and select vitamins and minerals were also highly variable. It was found that some patients survived for extended periods of time with very low intakes of food and fluids. Also, three patients who died during the study showed gradually declining intakes of food and fluids until death. In the second project, a structured interview was administered to 14 hospice patients and 18 family members to determine their knowledge, perceptions, attitudes, and wishes concerning tube feeding for seriously and terminally ill patients. Responses to the questions indicated that in general patients were less opposed to the use of aggressive means of nutrition support than were family members. Also, three of the patients, and only one family member indicated that they would want to receive tube feeding if they became unable to eat and drink by themselves. Both patients and family members mentioned circumstances related to patient autonomy and prognosis as reasons why it would be permissible to withhold tube feeding from a patient. The third project presents five case studies of hospice patients who died without receiving artificial nutrition or hydration. The patients' medical records were examined, and their nurses or family members were interviewed about their symptoms and conditions during the dying process. Results indicated that most of the patients experienced no anxiety or restlessness, no nausea or vomiting, and no additional pulmonary problems as death approached. In four patients, pain was either absent or under control. Although four patients stopped eating three to seven days before death, they did not appear to exhibit hunger or thirst during this time. All five patients were reported to have died peacefully. These case studies appear to support the position that terminal starvation and dehydration do not cause pain or discomfort to patients who die without tube feeding. In fact, such patients may experience relief from troublesome symptoms.