Geriatric Quick Consult      PEG Tube Decisions      Do #6

Discuss concerns about thirst and hunger.

Knowledge Action
Studies, mainly in terminal cancer patients, have shown that people at the end of their life do not experience distress as a result of hunger or thirst.

In fact, it is part of the natural dying process to gradually decrease food and fluid intake.

By the time patients with dementia stop eating and drinking they are in the terminal stages of their illness and are unlikely to appreciate hunger or thirst.

It is important to make the family aware of this and reassure them that the patient can be kept comfortable with good mouth care and sips of fluid as tolerated.
  • Make family aware of typical intake habits during terminal stages of illness.
However, powerful emotions are involved where thirst and hunger are concerned.

It is common for families to say, "we can't just let him/her starve to death".

If they decide not to have a PEG, they may experience guilt over perceived abandonment and fear of losing a loved one.

You need to reassure them that they are acting in the patient's best interests and support them as they grapple with these feelings.
  • Reassure and support the family.
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