Information on eating and drinking at the end of life

You can offer food and drinks if the person wants them and can safely manage them. Never force them to eat or drink, this can cause distress or harm.

Offer small sips or bites regularly, but stop if the person:

• is very drowsy
• doesn’t open their mouth
• can’t swallow or keep food in their mouth

If you’re unsure, ask us for advice.

If the person has religious or cultural wishes about food and drink near the end of life, please let us know so we can support these respectfully.

In some medical conditions, artificial nutrition or hydration might be considered. But in the final days of life, this usually doesn’t help and may cause more problems, such as:

• More mucus or fluid in the throat or lungs
• Feeling sick or vomiting
• Restlessness
• Difficulty breathing

• Offer small amounts of food and drink throughout the day.
• Choose favourite tastes or foods the person enjoys.
• Make sure they are sitting upright or supported in bed.
• Only feed them when they are fully awake.
• Give them time to swallow before offering more.
• If they cough or seem distressed, stop and try later.
• Provide mouth care every 2 to 4 hours, or more often if needed.
• Clean and moisten the mouth, including teeth, lips, tongue, and cheeks.
• Softer or thickened foods and drinks can be easier to swallow. A speech and language therapist can help with this.

Our speech and language therapists can:

• assess swallowing and give advice to make eating and drinking easier.
• recommend safer food and drink textures.
• help families plan for changes in eating and drinking.
• connect you with other support services for end of life care.

People nearing the end of life often rely on staff or caregivers for their mouth care. Sadly, this important part of care is sometimes forgotten or skipped. When the mouth isn’t looked after, it can lead to bad breath (halitosis), which can impact on contact with friends and family members as an unpleasant aroma from the mouth can be off putting causing loved ones to avoid having close contact or kiss the person.

Care plan

Mouth care should be part of the person’s care plan and focus on comfort and improving their quality of life. This can include:

• Pain relief
• Treating dry mouth
• Removing sticky or dry secretions
• How often the mouth should be rinsed or checked

This plan helps make sure care stays consistent, even when the person moves between care settings or has different caregivers.

Assessment

The main goal of mouth care at the end of life is comfort, not cure.

• Use gloves, a torch, and a tongue depressor to check the mouth.
• Take out any dentures before examining.
• Look for signs of pain, dryness, coating on the tongue, sores, infection, or tooth decay.

Dry mouth

People at the end of life often breathe through their mouth, which can cause dryness. A dry mouth is uncomfortable and can lead to thick, sticky secretions that are hard to remove.

• Use water or dry mouth gel on a soft toothbrush or a 360 toothbrush or MC3 stick to keep the mouth moist.
• If the person is awake, check and hydrate the mouth every 30 minutes.
• If the person is unconscious, do this at least every hour.
• Keep lips soft with water-based lip balm or gel.

Dried sticky secretions

As swallowing and coughing become weaker, saliva and mucus can build up in the mouth. These secretions can dry out and stick to the tongue and roof of the mouth, making them hard to remove.

Management

• Use a soft toothbrush or a special tool (like a 360 toothbrush) to gently clean these areas.
• Keeping the mouth clean and moist helps with comfort and dignity.

Involving loved ones

Letting loved ones help with mouth care can help them feel useful and connected, and it’s a way for them to show care and support.

End of life mouth care tips

• Check the mouth daily for changes.
• Remove dentures, clean with mild soap and water, and store them dry in a labelled container.
• Brush teeth gently with a soft brush and mild, non-foaming toothpaste.
• Clean the mouth as often as needed to keep it fresh and comfortable.
• Offer help to clean teeth or dentures if the person can still do some care themselves.
• If the person can’t tolerate a toothbrush, use damp gauze (moistened with water or mouthwash) wrapped around your finger to wipe the mouth.
• Use water-based lip balm to prevent cracked lips.
• Review medications that may be causing a dry mouth.
• For people who are conscious, hydrate the mouth every 30 minutes.
• For those who are unconscious, moisten the mouth at least every hour, or more often if needed.

Important warnings

Taste for pleasure is a way of keeping the mouth hydrated at the end of life with a person’s favourite flavour. Whilst there is not a problem with hydrating someone’s mouth with flavoured beverages such as flavoured squash, tea and coffee.

• Don’t use alcohol to hydrate the mouth. Even if it’s the person’s favourite drink, alcohol dries out the mouth and can make things worse.
• Don’t use foam swabs. These can be dangerous if the sponge tip comes off and could be a choking hazard.
• Be careful with glycerine swabs. Although they may seem helpful, glycerine actually dries the mouth out even more.
• Swabs are not good at cleaning teeth. Use a toothbrush or appropriate tool to remove plaque effectively.