Treatment and care towards the end of life: good practice in decision making

Meeting patients' nutrition and hydration needs


All patients are entitled to food and drink of adequate quantity and quality and to the help they need to eat and drink. Malnutrition and dehydration can be both a cause and consequence of ill health, so maintaining a healthy level of nutrition and hydration can help to prevent or treat illness and symptoms and improve treatment outcomes for patients. You must keep the nutrition and hydration status of your patients under review. You should be satisfied that nutrition and hydration are being provided in a way that meets your patients’ needs, and that if necessary patients are being given adequate help to enable them to eat and drink.


If a patient refuses food or drink31, or has problems eating or drinking, you should first assess and address any underlying physical or psychological causes that could be improved with treatment or care. For example, some patients stop eating because of depression, or pain caused by mouth ulcers or dentures, or for other reasons that can be addressed. If a patient needs assistance in eating or drinking that is not being provided, or if underlying problems are not being effectively managed, you should take steps to rectify the situation, if you can. If you cannot, you should inform an appropriate person within the organisation that is responsible for the patient’s care.


The offer of food and drink by mouth is part of basic care (as is the offer of washing and pain relief) and must always be offered to patients who are able to swallow without serious risk of choking or aspirating food or drink. Food and drink can be refused by patients at the time it is offered, but an advance refusal of food and drink has no force.


If you are concerned that a patient is not receiving adequate nutrition or hydration by mouth, even with support, you must carry out an assessment of their condition and their individual requirements. You must assess their needs for nutrition and hydration separately and consider what forms of clinically assisted nutrition or hydration may be required to meet their needs.