Decisions on eating and drinking in older adults admitted with pneumonia and referred for swallowing difficulties

Yuki Yoshimatsu; Dharinee Hansjee; Marianne Markowski; Ryan Essex; David G Smithard

doi:10.1007/s41999-024-00983-2

Decisions on eating and drinking in older adults admitted with pneumonia and referred for swallowing difficulties

Eur Geriatr Med. 2024 May 9. doi: 10.1007/s41999-024-00983-2. Online ahead of print.

Authors

Yuki Yoshimatsu^{1

2}, Dharinee Hansjee³, Marianne Markowski⁴, Ryan Essex⁴, David G Smithard^{5

6}

Affiliations

¹ Elderly Care, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Rd, London, SE18 4QH, UK. yukitsukihana0105@gmail.com.
² Centre for Exercise Activity and Rehabilitation, School of Human Sciences, University of Greenwich, London, UK. yukitsukihana0105@gmail.com.
³ Speech and Language Therapy, School of Health Sciences, University of Greenwich, London, UK.
⁴ The Institute for Lifecourse Development, University of Greenwich, London, UK.
⁵ Elderly Care, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Rd, London, SE18 4QH, UK.
⁶ Centre for Exercise Activity and Rehabilitation, School of Human Sciences, University of Greenwich, London, UK.

PMID: 38722516
DOI: 10.1007/s41999-024-00983-2

Abstract

Purpose: Older patients with pneumonia are commonly restricted from oral intake due to concerns towards aspiration. Eating and drinking with acknowledged risks (EDAR) is a shared decision-making process emphasising patient comfort. As part of our project to find the barriers and facilitators of EDAR, we aimed for this initial study to see how frequently EDAR was selected in practice.

Methods: We performed a retrospective cohort study at an acute hospital where EDAR was initially developed, of patients aged ≥ 75 years-old admitted with pneumonia and referred to speech and language therapy.

Results: Out of 216 patients, EDAR decisions were made in 14.4%. The EDAR group had a higher 1-year mortality than the modified/normal diet groups (p < 0.001). Pneumonia recurrence rate did not differ significantly between the groups (p = 0.070).

Conclusion: EDAR decisions were comparatively less common and most were associated with end-of-life care. Underlying reasons for the low EDAR application rate must be investigated to maximise patient autonomy and comfort as intended by EDAR while minimising staff burden.

Keywords: Aspiration pneumonia; Choking; Comfort feeding; Dysphagia; Modified diet; Risk feeding.

Abstract

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