Understanding Nutrition Changes in Hospice: Nourishing Comfort and Peaceful End-of-Life Journey

Published on March 8, 2024

Updated on March 2, 2024

As your loved one enters the final stages of their life, their nutritional needs will change. This article aims to provide you with insights into understanding the reduced calorie needs during this crucial time. It's important to know that these changes are a natural part of the body's process as it prepares for the end-of-life journey.

Estimated Calories Needed Per Day Over the Last Six Months

As a person approaches the end of life, their body undergoes a natural process of slowing down and conserving energy. This means that their calorie requirements also decrease over time. This is not a sign of starvation or distress. It is simply the body's way of adapting to the dying process. They may lose their appetite or thirst completely. Forcing them to eat more will not prolong their life or improve their quality of life. On the contrary, it may cause them or harm such as nausea or . Here is an estimate of how much calories they may need in each month before they die:

  • In the first month, they may need about 80-90% of their usual calorie intake.
  • In the second month, they may need about 70-80% of their usual calorie intake.
  • In the third month, they may need about 60-70% of their usual calorie intake.
  • In the fourth month, they may need about 50-60% of their usual calorie intake.
  • In the fifth month, they may need about 40-50% of their usual calorie intake.
  • In the sixth month, they may need about 30-40% of their usual calorie intake.

Estimated Daily Calories Based on Estimated Time Left

Estimated Time LeftEstimated Calories Needed per Day
Less than Six Months1,200 to 1,500 calories per day
Less than Three Months1,000 to 1,200 calories per day
Less than One Month800 to 1,000 calories per day
Less than Two Weeks600 to 800 calories per day
Last Week of LifeEnergy needs are minimal

Estimated Calories Needed Per Day Based on Awake Time

Another factor that affects how much food your loved one needs is how much time they are awake during the day. When someone is extremely sick and close to dying, they may sleep increasingly more. This is because their body is resting and preparing for the final transition. This is normal and not something to worry about. They may not want to eat or drink much when they are awake. This is also normal and part of the dying process. They may only need a few bites or sips to keep them comfortable. Here is how much food they may need based on how long they are awake:

  • If they are awake for 8 to 12 hours a day, they may need about half or a little more of the food they usually ate when they were healthy.
  • If they are awake for 6 to 10 hours a day, they may need about 40-50% of the food they usually ate.
  • If they are awake for 4 to 6 hours a day, they may need about 30-40% of the food they usually ate.
  • If they are awake for 1 to 2 hours a day, they may need about 20-30% of the food they usually ate.
Hours AwakeEstimated Calories Needed Per Day
8 to 12 hours per day1,000 to 1,200 calories per day
6 to 10 hours per day800 to 1,000 calories per day
4 to 6 hours per day600 to 800 calories per day
1 to 2 hours per dayEnergy needs are minimal

Estimated Calories Needed Per Day on Based on Activity Level

Another factor that affects how much food your loved one needs is how active they are during the day. When someone is extremely sick and close to dying, they may not be able to move around much. This is because their body is weak and tired. This is normal and not something to be ashamed of. They may not need as much food as before because their body is using less energy. Trying to make them eat more will not make them stronger or happier. It may only cause them pain or trouble. Here is how much food they may need based on how active they are:

  • If they can walk around the house a little bit, they may need about 10-15% of the food they usually ate when they were healthy.
  • If they can only move from the bed to the chair and back, they may need about 5-10% of the food they usually ate.
  • If they cannot get out of bed at all, they may need only 1-5% of the food they usually ate.
Activity LevelEstimated Calories per Day
Walking around the houseAbout 600 to 800 calories
Living a chair-to-bed existenceAbout 400 to 600 calories
Totally bedboundAbout 200 to 400 calories

How the Brain Prepares the Body for Death

When someone is dying, their brain is working hard to help them let go of life. The brain sends signals to the body to slow down and conserve energy. The brain also reduces the production of hormones that make us feel hungry and thirsty. This is because the body does not need as much food and water as before. This is not a sign of suffering or neglect. It is a sign of the body's natural wisdom and adaptation. Your loved one may not have the same appetite or thirst as a healthy person. They may only need a few bites or sips to keep them comfortable. This is normal and part of the dying process. It helps them to be more peaceful and relaxed as they get closer to death.

Supporting Changes in Appetite

When someone is extremely sick and close to dying, they may not want to eat as much as before. This can be hard to accept, but it is normal and part of the dying process. They may not need as much food as before because their body is slowing down and preparing for the final transition. Trying to make them eat more will not help them live longer or feel better. It may only cause them or trouble. Instead, there are ways to make them feel more comfortable and loved:

  • Offer small, nutrient-dense meals: Give them small portions of food that are rich in protein, vitamins, and minerals. This can help them get the nutrients they need without feeling too full or bloated. You can also offer them their favorite foods or foods that are easy to swallow and digest.
  • Focus on hydration: Make sure they drink enough water or other fluids to stay hydrated. You can offer them sips of water, juice, milk, tea, or soup throughout the day. You can also use a moist sponge or cloth to wet their lips and mouth if they cannot drink.
  • Respect preferences: Listen to what they want and do not want to eat or drink. Do not force them to eat or drink something they do not like or are not in the mood for. Respect their choices and preferences. They know their body best and what makes them comfortable.
  • Create a calm environment: Make the mealtimes a relaxing and pleasant experience. You can play some soft music, light some candles, or use aromatherapy to create a soothing atmosphere. You can also remove any distractions or noises that may bother them or make them lose their appetite.
  • Engage in gentle conversation: Talk to them in a gentle and loving way during meals. You can share some positive memories, express your gratitude, or tell them how much you care for them. You can also ask them how they are feeling or what they need. Avoid talking about stressful or upsetting topics that may make them anxious or depressed.

Conclusion

Understanding the reduced calorie needs as your loved one approaches the end of life is crucial for providing compassionate and effective care. These changes are a natural part of the body's process and require empathy, support, and adjustment in their care routine.

Resources

Understanding the Role of IV Fluids at the End of Life

Tube Feeding on Hospice — Increased Risk of Your Loved One Suffering

Dietary progression through end of life

Food and liquids during the dying process

Is my loved one starving or being dehydrated to death?

Hospice: How Long Can One Live Without Food and Water?

Nutrition in Palliative Care – Session 4 – how to treat poor appetite (video)

Strategies for Optimal Calorie Administration in Critically Ill Patients

Energy Expenditure – An Overview

American Cancer Society Calorie Counter

Estimated Calorie Needs per Day by Age, Gender, and Physical Activity Level

Eating and Drinking at End-of-Life — Beth Cavenaugh

What Can a Hospice Patient Eat and Drink – Samaritan Hospice Blog

Nutrition in Cancer Care

No Food or Water on Hospice: Is It OK if Patient Stops Eating

Eldercare Locator: a nationwide service that connects older Americans and their caregivers with trustworthy local support resources

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