What is Eating and Drinking with Acknowledged Risk?

Eating and Drinking with Acknowledged Risks (EDAR) is the term used to describe eating and drinking where there may be risks of aspiration, that is, food going down into the lungs instead of into the stomach or ‘going down the wrong way’, choking and malnutrition and dehydration. 

EDAR ensures quality of life is the highest priority. A speech and language therapist will assess and will recommend food and drink consistencies that can reduce but not eliminate the risk of aspiration. Sometimes food or fluid modification will not improve the safety of the swallow at all and the person should eat and drink whatever they wish. 

What to expect when eating and drinking 

When eating and drinking the person may experience any of the following: 

  • food or drink collecting in the mouth
  • coughing or choking 
  • a wet, gurgly voice or noisy breathing 
  • shortness of breath after eating and drinking

Advice to help make eating and drinking more comfortable: 

  • it is important to be alert and sit upright where possible
  • take one, small, mouthful of food or drink at a time
  • appetite may be smaller than normal
  • little and often approach to mealtimes and drinks may be easier
  • take time for each mouthful to be swallowed. You or the person feeding you can check all the 
  • food is gone before having any more
  • it may be helpful to have assistance to eat and drink. The person providing assistance can also follow these recommendations. 

When to stop and try again later

If you are:

  • uncomfortable or distressed
  • drowsy or very sleepy and unable to stay awake long enough to eat or drink 
  • unable to swallow - you are holding food or drink in the mouth.

The priority is for the person to be comfortable. You may wish to talk to your doctor if you have any discomfort, your health deteriorates and/or you wish to change your mind about eating and drinking with acknowledged risks. Your GP should be the point of contact for further management once you have been discharged from hospital.

Importance of good oral hygiene 

Good oral hygiene is important for comfort, and to ensure that bacteria does not build up in the mouth which can be carried to the lungs and lead to increased risk of chest infections.

  • your mouth and teeth should be cleaned a minimum of twice a day. This includes before and after eating. You may need assistance from nursing or care staff.
  • ensure you sit upright and lean forward to avoid toothpaste falling back into the throat during mouthcare
  • clean teeth and tongue gently using a small soft toothbrush and a small amount of low foaming fluoride toothpaste
  • spit or suction any toothpaste out after brushing

Dentures

  • dentures should be removed and cleaned regularly with denture cleaner
  • if dentures are very loose it may be best to eating and drink without them or use denture adhesive to fit them.
  • avoid leaving dentures in when lying back, or if you are sleeping or drowsy.

Advanced care planning

The medical team may also want to discuss with you or your relative how any future aspiration-related pneumonias will be managed including future antibiotic treatment and readmission into hospital. The focus should be on enhancing quality of life. 

Patient choice 

The decision to continue feeding with acknowledged risks is normally made by the person, with support from their family or significant others and relevant medical professionals, particularly if the
person does not have capacity and cannot make the decision. The person’s wishes, cultural and ethical beliefs are key to making the decision. 

A decision to continue feeding with acknowledged risks is not permanent. If you or your relative decides that they no longer want to eat and drink with risk, this should be discussed with your doctor who will help you to reconsider the available options. If you have any further questions, please contact your named speech and language therapist.