LAUSR

We examined the frequency of different decisions, including eating and drinking with acknowledged risks (EDAR) in a single-institution retrospective study of older people with pneumonia and swallowing difficulties. EDAR decisions were made in only a small fraction of patients (less than one fourth of patients on a modified diet). Most EDAR decisions were for end-of-life comfort care, and patients for EDAR had a significantly higher mortality despite the pneumonia recurrence rate not differing significantly. The reasons underlying the relatively low frequency of EDAR decisions compared to modified diet needs to be investigated to maximise patient autonomy and comfort while minimising staff burden. 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. 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. 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). 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.