Swallowing problems (dysphagia) may result from dementia, stroke, various neurological disorders (such as Parkinson’s disease, multiple sclerosis, motor neurone disease), COPD, learning disability and a range of other acute and chronic health conditions.
If you or your relative is experiencing swallowing difficulties, there may be a high risk of food, fluid, and saliva ‘going down the wrong way’. This is when it enters the windpipe or lungs. This is known as aspiration. Aspiration can be uncomfortable, although sometimes it happens with no immediate signs or symptoms (silent aspiration). Aspiration can be dangerous as it can cause pneumonia (an infection in the lungs) or choking, either of which can cause death.
Speech and Language Therapists specialise in the assessment and treatment of dysphagia and in many cases are able to find ways to reduce the risks for people with swallowing difficulties.
However, for some patients, even with this support, their swallow is not safe.
There are many people, who despite having an unsafe swallow, are unsuitable candidates for tube feeding or clinically assisted nutrition and hydration (CANH) such as NGT, PEG, RIG for the following reasons:
• The risks of tube feeding outweigh the benefits
• Informed consent is not given for tube feeding
• Tube feeding would not maintain or improve the patient’s quality of life
“Eating and drinking with acknowledged risks” should be considered when patients have an unsafe swallow on all food and drink and or those who do have a safe swallow on modified recommendations but do not wish to follow this advice and are not suitable for tube feeding.
When a person continues to eat and drink despite a risk of aspiration this is referred to as eating and drinking with acknowledged risks. This may be put in place for one or more of the following reasons:
• Advanced stages of illness
• The person’s swallow is not safe and is unlikely to improve
• When preferred food and drink takes priority over swallow safety
• Tube feeding options are declined or inappropriate
• The person wishes to continue to eat and drink for quality of life.
An eating and drinking with acknowledged risks decision should result in a plan which balances safety and quality of life as equally as possible, taking fully into account the personal, cultural, and religious beliefs of the individual.
If a person is eating and drinking with acknowledged risks, a Speech and Language Therapist will recommend ways to manage the risks associated with eating and drinking. These may include:
• Changes to consistencies of food and/or drink
• Support to increase independence with eating and drinking
• Advice about positioning while eating and drinking
• Advice about amounts of food and drink to have
• Advice about speed of eating and drinking
• Regular mouthcare.
• Instrumental Swallow Assessment such as Flexible Endoscopic Evaluation of Swallowing (FEES) and Video fluoroscopy (VFS).
The aim of this advice is to reduce distress for the person who is eating and drinking with acknowledged risks, wherever possible. Speech and Language Therapists are happy to answer your questions and explain the actions you can take to manage risks. You can talk this through with your Speech and Language Therapist or if you have urgent concerns, please contact us using the phone number on the back cover.
Adult Speech and Language Therapy
Blackpool Victoria Hospital
Whinney Heys Rd
Blackpool
FY3 8NR
01253 953873
