Eating and Drinking in the Last Hours to Days of Life, including Tastes for Pleasure

Eating and Drinking in the Last Hours to Days of Life, including Tastes for Pleasure

EATING AND DRINKING IN THE LAST HOURS TO DAYS OF LIFE

Those in the last hours to days of life often eat and drink less than usual or not at all, this can happen due to the following reasons:

• The body slowing down and their energy requirements decreasing.
• Having difficulty processing food and drink.
• Being too sleepy or weak to swallow.
• Loss of interest or appetite for food and drink.
• Tube feeding does not usually provide comfort or improve quality of life and can be distressing.

Reduced oral intake is often a concern for families and carers but it is a natural and expected part of the dying process as most people do not experience hunger or thirst at the end of life.

Advice for continued eating and drinking:

Any foods that do not require much chewing may be easier to manage.
Suggestions for small portions or snacks:

• Porridge, Ready Brek, semolina, Weetabix.
• Ice-cream, ice lolly, lassi or kulfi.
• Pots of yogurt, custard, fromage frais, fruit puree, instant whip/mousse, panna cotta, rice pudding.
• Soft fruit e.g. banana, tinned mandarins/peaches.
• Small pieces of cake in custard or cream. Favourite sweets or chocolate.
• Smooth soup.
• Pieces of cheese (grated or cut into small squares), soft cheese triangles.
• Scrambled egg, small pieces of omelette. Small portion of mashed potato.
• Soft filled sandwiches e.g. cream cheese, egg mayonnaise, tuna mayonnaise, pate, hummus, avocado.
• Melty crisps e.g. Quavers, Wotsits, PomBears (or equivalent).
• Drinks: milkshakes, smoothies, hot beverages, fruit juice, squash, fizzy drinks. Use an open cup, avoid spouted beakers as they do not have to tip their head back as much. Avoid straws.

TASTES FOR PLEASURE

If oral intake becomes too distressing, for example, coughing and spluttering, for those who are unable to swallow or no longer wish to have food and drink, they may find comfort in tasting their favourite flavours instead through ‘TASTES FOR PLEASURE’.

What does this mean?
‘Tastes for Pleasure’ means that when receiving end of life mouth care (cleaning and hydrating the mouth) this can include using an individual’s favourite liquid flavours to provide moisture. These flavours can be anything from tea, coffee, Bovril to orange squash or even Prosecco (or other spirits)!

Why are we using this?

• Around 80% of hospital patients will have swallowing difficulties in the last 72 hours of life.
• To change the culture of people dying whilst being ‘Nil by Mouth’ (NBM).
• To encourage an ethos for the dying person to focus on comfort measures when eating and drinking is no longer possible.
• We only get ‘One Chance to Get It Right’ to improve people’s experience of care during the end of their life.

Who is it for?
For individuals who are in their last days or hours of life and who are on an Individualised Last Days of Life Care Plan for Adults (ILDoL), more commonly known as End of Life Care.

Who can provide Tastes for Pleasure?
Anyone!

• Hospital staff
• An individual’s family, friends or carers.

When can it be done?
Anytime!
As often or as little as desired.

• Tastes for Pleasure should not replace good oral hygiene and mouth care.
• First ensure the mouth is sufficiently clean.
• Then provide Tastes for Pleasure – see guidelines on the next page.

TASTES FOR PLEASURE GUIDELINES

1. First ensure the mouth is sufficiently clean. Mouth-eze sticks or Stryker suction sponges can be used to effectively clean mouths.
   • Please ask one of the nursing team to clean their mouth or show you how to do so.
2. Using a MouthEze stick dip this into a cup of the individual’s favourite flavoured liquid*.
   • Tap away excess fluid.
3. Apply to the individual’s lips, tongue or inner cheeks.
4. Repeat as often as desired.

TASTES FOR PLEASURE BEDSIGN

We have created a bed-sign to be used with individual’s receiving Tastes for Pleasure.

All resources have been produced by the Speech and Language Therapy Department in conjunction with the Hospital Palliative Care Team at Worcestershire Acute Hospitals Trust.

Tastes for Pleasure was inspired by the original work from The Shrewsbury and Telford Hospital NHS Trust.

Additional eating and drinking advice provided in collaboration with the BDA (British Dietetic Association).

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.  

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