GPAtlas🧭 When to initiate the conversation
This article covers anorexia, weight loss and reduced oral intake in people with a progressive, life-limiting illness – including the last days of life. The single most important idea to hold, and to share, is the reframe: a dying person is not dying because they have stopped eating; they have stopped eating because they are dying. Reduced intake is a normal, expected part of the dying process, and in the last days how much someone eats or drinks does not change how long they live.
Management diverges sharply depending on where the patient sits on this trajectory, so it helps to decide that first.
| Phase | What is happening, and what the goal is |
|---|---|
| Dying over weeks to months (anorexia–cachexia) | Appetite and weight loss are driven by the underlying illness and are largely irreversible. The priority is to treat reversible contributors and support the patient and family. A short, time-limited trial of an appetite stimulant occasionally helps wellbeing but does not restore weight or nutritional status. |
| Last days of life | Eating and drinking less is normal and expected. The goal is comfort – meticulous mouth care, symptom control and an individualised approach to hydration. Clinically assisted nutrition, and routine hydration, are rarely of benefit and may cause harm. |
Engage both the patient and those important to them, who are often more distressed by the changes than the patient is. The work is largely communication and symptom control, aligning care with the patient's wishes. Any decision to start, continue or stop clinically assisted nutrition or hydration (CANH) must comply with the Mental Capacity Act 2005 and NICE Guideline NG31.
Source: NICE NG31 · GMC
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