From the Guidelines
Hospice patients can typically survive without nutrition or hydration for approximately 1-3 weeks, though this varies significantly based on individual factors, as supported by the most recent and highest quality study available 1. The process, known as voluntary stopping of eating and drinking (VSED), often results in death within 10-14 days for most patients. Factors affecting survival time include the patient's initial hydration status, underlying condition, age, and metabolic rate. Patients with more body fat or who were well-hydrated before stopping intake may survive longer, while those who are already frail may decline more rapidly. During this time, the body gradually shifts to ketosis, using stored fat for energy, which can temporarily sustain vital functions. As dehydration progresses, patients typically experience decreased consciousness and eventually a peaceful death from cardiac arrest.
Key Considerations
- The decision to stop nutrition and hydration should be made with consideration of the patient's autonomy and quality of life, as emphasized in the guidelines 1.
- Artificial hydration and nutrition are unlikely to provide any benefit for most patients in the terminal phase, and may even cause discomfort or metabolic distress 1.
- Hospice care during this process focuses on comfort measures including mouth care to prevent dryness, lip balm application, and medications for symptom management such as haloperidol for nausea or morphine for discomfort.
Clinical Implications
- The primary goal of care for hospice patients without nutrition or hydration should be to provide comfort and alleviate suffering, rather than to prolong life 1.
- Family members and caregivers should be educated and supported in the care of the dying patient, and their psychosocial distress should be addressed through communication and educational interventions 1.
- Respect for the patient's religious, ethnic, and cultural background is essential in making decisions about end-of-life care, including the withdrawal or withholding of artificial nutrition and hydration 1.
From the Research
Expected Survival Time of a Hospice Patient
The expected survival time of a hospice patient without nutrition or hydration is not explicitly stated in the provided studies. However, some studies provide information on the role of nutrition and hydration in hospice care:
- A study from 2012 2 discusses the role of parenteral nutrition and hydration in terminal patients, highlighting that cachexia is refractory to treatment at the last stages of life and that the majority of terminally ill patients will derive no benefit from parenteral nutrition.
- A 2020 study 3 explores the benefits and risks of artificial hydration at the end of life, concluding that there is a lack of clear evidence regarding its benefits and harm.
- Another study from 2020 4 provides an overview of hospice and palliative care, stating that hospice is palliative care for patients with a prognosis of 6 months or less.
Factors Influencing Survival Time
Several factors can influence the survival time of a hospice patient, including:
- The patient's overall health and functional status
- The presence of symptoms such as delirium, which may be reversible with hydration 2, 3
- The patient's diagnosis and prognosis
- The patient's and family's desires and beliefs regarding artificial nutrition and hydration 5
Decision-Making Process
The decision to provide or withhold artificial nutrition and hydration in hospice care is complex and should be made in the context of the patient's desires, beliefs, and medical prognosis:
- A 2021 study 5 highlights the importance of considering the patient's and family's attitudes and beliefs when making decisions about artificial nutrition and hydration.
- The study also suggests that palliative care teams may benefit from the involvement of a Registered Dietitian to help navigate the decision-making process.