In the end stages of CHF, how long can you live without eating or drinking?

A fellow caregiver asked...

My husband's 85 year-old grandfather has stage 4 congestive heart failure. He was given morphine to induce a coma and hasn't had nourishment in over 4 days. He gets a few trickles of water through a straw every 8 hours or so. How long can he survive like this?

Expert Answer

Audrey Wuerl, RN, BSN, PHN, is education coordinator for Hospice of San Joaquin in California. She is also a geriatric trainer for the End-of-Life Nursing Education Consortium (ELNEC), which promotes education in geriatric nursing and end-of-life care.

Life expectancy after stopping food and water with congestive heart failure would depend on the progression of the disease process. Stage 4 suggests advanced disease, where even minimal physical activity would result in difficulty breathing and pain with any activity. His body is probably very tired and weak. He may have had difficulty eating for some time now. Further, he is 85 years old, and no doubt, has been fighting this disease for many years. While it is impossible to state how long he can survive, some people can actually live several weeks without food if they are well nourished. This probably would not be the case here. However, without water, that period is shortened. At the end of life, people tend to drift in and out of consciousness and may actually appear to be in a coma. I mention this because morphine is not used to induce a coma; it is a drug used to treat pain. No doubt, it was administered to treat the pain your husband's grandfather was experiencing. If he appears peaceful, his pain is probably controlled and he is going through the "dying process" as his body prepares for death. In hospice care, using swabs to moisten the mouth is advisable when people are unable to swallow or who are unconscious. Losing the ability to swallow is a normal, physiological change as death approaches. Giving water through a straw could cause him to aspirate, drawing water into his lungs. (I'm assuming he is receiving hospice care, since you mention morphine.) Keeping him comfortable now, pain and symptom managed, will allow a peaceful life closure with dignity and respect.