Why intake falls
Appetite, the ability to swallow and the body’s need for food all change as a life-limiting illness advances. Near the end of life, eating less is part of the illness, and in the last days a person will likely not want or need food 29.
Families sometimes worry that the person is starving or thirsty. Gentle mouth care and small sips or tastes, if the person can swallow safely and wants them, are the usual ways to keep the mouth comfortable. Oral care is one of the things the Standards require providers to give in the last days of life 3.
Drips and fluids under the skin
Fluid can be given through a drip into a vein or under the skin. The question is whether it helps someone who is dying.
In a double-blind trial in six hospices, 129 people with advanced cancer were given either a litre of fluid a day or a small placebo amount. There was no difference in symptoms linked with dehydration, quality of life or survival 20. A 2023 Cochrane review found four randomised trials with 422 participants, all with advanced cancer, and concluded that there is not enough evidence to say whether medically assisted hydration improves quality of life or survival. The authors noted that the findings do not transfer to dementia or other non-cancer illnesses 19.
There are no trials of artificial hydration in Australian residential aged care. Decisions are made case by case, weighing the possible benefit against the burden of a line, fluid overload or more secretions.
The evidence
Medically assisted hydration in the last weeks of life
Uncertain / conflictingThe best trial found no symptom benefit, but the overall evidence is too thin to say for certain, and none of it is in aged care.
The evidence
No difference in dehydration symptoms, quality of life or survival in a placebo-controlled trial of 129 hospice patients with cancer 20. Cochrane rates the evidence on quality of life and survival as very low certainty 19.
In practice
All trial participants had advanced cancer. The Cochrane authors caution against applying the results to dementia or other non-cancer illness 19.
Feeding tubes in advanced dementia
A 2021 Cochrane review found no randomised trials of tube feeding in severe dementia. Its 14 non-randomised studies were all at high or very high risk of bias. They found no evidence that tube feeding improves survival, quality of life, comfort or nutrition, some evidence of more pressure injuries with gastrostomy tubes, and a balance of evidence suggesting more pneumonia 18.
Because there are no randomised trials, this is not graded here. The dementia section covers tube feeding and careful hand feeding in more detail.
Comfort-focused eating and drinking
-
Offer, do not push. Small amounts of food and drink the person enjoys, at their pace, when they are awake and comfortable.
-
Sit up and slow down. Position and pace often matter more than the menu. A speech pathologist can advise on texture and safe swallowing.
-
Mouth care. Moist swabs, lip balm and regular mouth care keep a dry mouth comfortable when the person can no longer drink much.
-
Eating with risk. Some people choose to keep eating food they enjoy even though there is a risk of choking or aspiration. That choice can be respected and recorded, in the same way as other choices that carry risk.
-
Stopping when they stop. When the person turns their head away or keeps food in their mouth, it is usually time to stop and try again later.
Related pages on this site
Sources cited on this page
- 3 Australian Government Department of Health, Disability and Ageing. Strengthened Aged Care Quality Standards (November 2025; implemented 1 November 2025). Outcome 5.7 Palliative care and end-of-life care, Actions 5.7.1 to 5.7.4. View source
- 8 End of Life Law for Clinicians / End of Life Law in Australia, Australian Centre for Health Law Research, Queensland University of Technology. Advance directives: Queensland. (Accessed October 2026; page undated.) View source
- 18 Davies N, Barrado-Martín Y, Vickerstaff V, et al. Enteral tube feeding for people with severe dementia. Cochrane Database Syst Rev. 2021;8:CD013503. (No randomised trials; 14 controlled non-randomised studies, all at high or very high risk of bias from confounding.) View source
- 19 Buchan EJ, Haywood A, Syrmis W, Good P. Medically assisted hydration for adults receiving palliative care. Cochrane Database Syst Rev. 2023;12:CD006273. (Four randomised trials, 422 participants, all with advanced cancer.) View source
- 20 Bruera E, Hui D, Dalal S, et al. Parenteral hydration in patients with advanced cancer: a multicenter, double-blind, placebo-controlled randomized trial. J Clin Oncol. 2013;31:111–8. (129 patients from six hospices.) View source
- 29 ACT Government. When someone is dying. (Last updated 16 December 2025.) View source
See every source cited across the palliative and end-of-life care section →
Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at October 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. It is not legal advice. Evidence, Australian regulatory requirements and state laws on advance care planning, substitute decision-making and voluntary assisted dying change — always confirm current advice with the treating GP, the state health department or a lawyer.
This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.