Traditionally, water and food are thought to be the foundation to existence. Providing water and food to our loved ones can be a method used to our care and appreciation for them. The thought of not providing them with these essentials can lead to a feeling of no concern for our loved ones; however, according to the American Medical Association, "some patients at the end of their lives voluntarily refuse oral fluid and food". The will of such patients (still maintaining the confidence to make decisions for themselves) must be respected, and aggressive rehydration and forced feeding should not be employed (CRHCF,2015).
Consequently, this is a common and normal phase for patients who are approaching end of life. Nonetheless, it can be a difficult process to watch, and it is common for families resist this transition. Feeling that your loved one is close to death can be pitiful and heart-breaking and can cause a psychological, emotional, and spiritual impact on family members (CRHCF,2015).
In scenarios like this, hospice care would be ideal for the patient. Hospice care's (hospice nurse) social workers can give advice, educate, and support the family as well as help family members discuss the benefits and side effects of introducing artificial hydration such as the use of IV fluids which include hypodermoclysis, i.e. transfusion of fluid into subcutaneous tissues (CRHCF,2015).
What are the benefits of providing artificial hydration?
The benefits will be explained with research.
A study of 100 hospice care patients hydrated by IV fluids concluded this therapy could be helpful in achieving better control on symptoms. Four patients reported enhanced cognitive functions, and some also reported less restlessness (CRHCF,2015).
Dehydration is a natural anaesthetic.
Dehydration is a normal process during the last days of life that act as a natural anaesthetic at the end of life. This anaesthetic effect can be explained in the following different ways:
- Fewer bouts of vomiting due to reduced gastrointestinal fluid.
- Decreased oedema and swelling.
- Decreased urine (CRHCF,2015).
- Less repetitive IVs and needles sticks.
- IVs may restrict the patient and act as a hindrance for the family.
- Increased naturally occurring endorphins or opioid peptides providing the highest state of well-being.
- Reduction in pulmonary fluids (secretions) with less choking, coughing, and need for suctioning.
- Fluids can cause enhanced cognition of an individual in pain and make him or her more aware of pain (CRHCF,2015).
Steps to be followed to reduce dehydration at the end of life
The hospice team guides the patient to follow some steps in order to reduce dehydration at the end of life. These steps are as follows:
- Spray the normal saline solution into the mouth for comfort.
- Rinse his or her mouth frequently.
- Dip oral swab our soft toothbrush (purchased at a pharmacy or provided by hospice company) in fluid and allow the individual to suck and slowly swish around his/her mouth (CRHCF,2015).
- Use a fan, air conditioner, or any room humidifier but ensure that patient does not get too cold.
- Use lip lubricant.
- Sipping on Chamomile tea has a soothing effect on a dry mouth but only use it when the patient is willing.
- There is a risk of aspiration when the patient is unable to swallow fluid. For this reason, don't offer fluids in such conditions.
- Offer small popsicles, ice chips, and small sips of fluid (CRHCF,2015).
Tips for hydration at the end of life
Throughout life, staying hydrated is very important for a healthy and good life. Water is important to help maintain body temperature and other bodily functions. When the body loses water in the processes of digestion, sweating, and breathing, it must rehydrate by intaking water and fluids.
But at the end of life, these requirements change because the body is no longer in good health. As the body begins to slow down, it would not need as much hydration and liquid intake as it once did. This is the way the body of preparing itself for terminal life and is a natural reaction of the body to old age (Crossroads,2018).
Drinks for hydration: Good at terminal life
There are some drinks that are great for hydration at the end of life. So, the hospice team guides the family members to offer these drinks to their loved ones.
Cherry Lime Infused Water
The first drink is a cherry lime-infused water. It is very good for hydration because its main component is water; the included fruits are enough to give a bit of flavour without affecting the blood sugar level of the patient. We will discuss its brief recipe as follows.
Ingredients:
- Water
- Ice
- Four pitted cherries
- Two slices of lime
Steps:
- Fill glass with ice and water. Add the cherries and lime (feel free to squeeze lime for flavour).
- Place for 5 minutes for it to mix thoroughly.
- Serve (Crossroads,2018).
Strawberry Ginger Switchel
Image source: https://www.recipestonourish.com/strawberry-ginger-switchel/
This drink includes:
- cider vinegar
- honey
- Strawberry
- lemon juice
- and ginger.
This drink has to sit overnight before use to achieve the complete effectiveness of ingredients (Crossroads, 2018).
End of life events can bring many changes to the patient’s body, one of which is dehydration. Dehydration is often treated but toward end-of-life treatment can look very different. Although dealing with end of life can be difficult for both the patient and the family, hospice can assist with the process and provide the family with emotional support as well assist with clinical treatment for the patient.
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References
- Foundation, C. (2015). Terminal Dehydration. Retrieved 10 June 2021, from https://crhcf.org/insights/terminal-dehydration/
- Tips for Hydration at End of Life. (2018). Retrieved 10 June 2021, from https://www.crossroadshospice.com/hospice-palliative-care-blog/2018/july/25/tips-for-hydration-at-end-of-life/