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Nutrition for the dying and patients with severe dementia
Last reviewed: 08.07.2025
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Anorexia or loss of appetite is common among dying patients. Behavioral approaches (eg, flexible meal times, slow feeding, small portions, favorite or highly flavored foods) often increase oral intake. Drinking a small amount of a favorite alcoholic drink 30 minutes before meals may also help. Certain antidepressants may also stimulate appetite: megestrol acetate and dronabinol. Metoclopramide increases gastric emptying, which may also increase appetite, but may take 1 to 2 weeks to reach peak effectiveness.
Progressive dementia eventually leads to the inability of patients to feed themselves; sometimes such patients are fed through a tube. However, there is no convincing evidence that tube feeding prolongs life, provides comfort, improves function, or prevents complications (aspiration, pressure ulcers).
Tube feedings and parenteral nutrition are uncomfortable and are not usually indicated for patients who are dying or who are severely demented and unable to eat. Family members may find it difficult to accept the loss of parenteral nutrition, but they should understand that these patients may prefer their own choice of food and drink. Small sips of water and easy-to-swallow foods may be helpful. Supportive care, including good oral hygiene (brushing teeth, moistening the mouth with swabs and ice chips as needed, lip ointment), can provide physical and psychological comfort to the patient and family members providing the care. Specialist counseling and advice may be helpful for family members who are concerned about the need for invasive parenteral nutrition.
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