Anorexia or loss of appetite is common among patients who are dying.
Measures that may increase oral intake include
Using flexible feeding schedules
Feeding slowly
Giving small portions or favorite or strongly flavored foods
Certain antidepressants, megestrol acetate, and dronabinol may stimulate appetite. Metoclopramide enhances gastric emptying, but it may take 1 to 2 weeks to reach peak effectiveness.
Advanced dementia eventually leads to inability to eat; sometimes affected patients are given enteral nutrition. However, there is no convincing evidence that enteral nutrition prolongs life, provides comfort, improves function, or prevents complications (eg, aspiration, pressure injuries).
Enteral and parenteral nutrition cause discomfort and are usually not indicated for patients who are dying or unable to eat as a result of their dementia. Forgoing nutritional support may be difficult for family members to accept, but they should understand that patients are usually more comfortable eating and drinking as they choose. Sips of water and easy-to-swallow foods may be useful. Supportive care, including good oral hygiene (eg, brushing the teeth, moistening the oral cavity with swabs and ice chips as needed, applying lip salve), can physically and psychologically comfort the patients and the family members who provide the care. Patients should be encouraged to enter a hospice program, which can provide the needed support.
Counseling may help family members who are dealing with anxieties about whether to use invasive nutritional support (see Parenteral Nutrition and Enteral Nutrition). Palliative care physicians are specifically trained to comfort patients and family members; early consultation with a palliative care team is encouraged.
