Symptomatology of Dying 3: Anorexia

As a review, some of the symptoms of dying that I have mentioned to some degree in previous posts include:

One to three months prior to death:
-Withdrawal from the world and people

One to two weeks prior to death:
-Confusion
-Picking at tubing (or clothing)

Days or Hours prior to death:
-Fixed stare (Eyes glassy, tearing, half or fully open)
-death rattle

Next I want to talk about anorexia. Although anorexia is commonly known as an eating disorder, it literally means "loss of appetite." As people approach death, it is very normal for us to lose interest in food or beverages. To some degree, a level of starvation and dehydration are the normal processes for dying.

This symptom may present even before an official terminal diagnoses is made. Although anorexia is normal in the dying, this does not mean that just because someone has been given a terminal diagnosis with a life expectancy of six months that they should not eat. So long as a reasonable quality of life is left, people should be encouraged to eat well. People at the end of life should be encouraged to eat their favorite foods without regard to their fat or calorie content. Protein and energy drinks (including homemade smoothies and milkshakes as well as premade beverages such as Ensure) may give the dying more energy and thus a higher quality of life in their last few months.

However, when people get within the last few weeks of their life, even the most favored foods may no longer be desirable. Families frequently have a very difficult time accepting that their loved one is refusing to eat. However, food should never be forced on the dying.

Forcing food may be detrimental in a number of ways. As referred to in the death rattle posting, as people die, their ability to swallow frequently becomes compromised. Forcing foods on them may cause them to choke or develop pneumonia. In addition, forcing food may prolong life and make your loved ones transition more difficult and possibly more painful.

Many hospice advocates, including Christine Longaker, believe that towards the end of life, there is a shift away from obtaining and using energy from food sources and towards obtaining and using energy for spiritual purposes. This view may help family members who worry that their loved one is uncomfortably hungry and family members who continue to attempt to force feed their loved ones.