12 `Risk feeding` for Older People: a Retrospective Case Series to Review the Decision Making Process (Age and Ageing)

AbstractBackground`Risk feeding` is a term commonly used when an individual continues to eat and drink despite a perceived risk of choking or aspiration. It is suspected that there is significant variability around how a decision of `risk feeding` is made for older people in the acute hospital setting, particularly whether or not the individual and his/her family are involved. This is of particular interest under the Assisted Decision Making (Capacity) Act 2015.AimsTo investigate individuals` participation in decision-making regarding `risk feeding`To investigate the duration individuals are kept NPO pending `risk feeding` decisionsMethodsA retrospective case series was completed. 18 medical charts were reviewed for collection of the following data: Average length an individual was NPO pending decision regarding oral intakeDiscussion between individual and medical team regarding oral intakeThe individual`s capacity for decision making regarding oral intakeDiscussion of what is in the best interests of the individualDiscussion with family/NOKExplicit plan regarding oral intakeResultsAverage length NPO: 1 day (range 0-4 days)Discussion with patient: 17%Patient capacity for decision making: 17%Best interests discussion: 66%Discussion with family/NOK: 77%Explicit plan: 66%ConclusionThere is significant variability in decision making for `risk feeding` with older adults in the acute hospital setting. Individuals are not consistently involved in their plan to `risk feed`. In some cases there was reliance on family members to decide on `risk feeding`, in others the medical team made decision in the best interests of the individual. Individuals are being kept NPO for a period of time to allow decision making, without knowledge of why this is so.The review highlights the need for individual involvement in decision regarding dysphagia and oral intake. Multidisciplinary education and guidance is recommended to ensure consistent ethical decision making.