View the multidisciplinary guidance on eating and drinking with acknowledged risks.
What is eating and drinking with acknowledged risks?
Eating and drinking with acknowledged risks refers to the decision to continue eating and drinking despite the associated risks from having dysphagia. These risks may refer to aspiration, malnutrition, dehydration and choking.
Terms such as ‘risk feeding’, ‘eating and drinking with accepted risk’, and ‘feeding at risk’ remain contentious among some groups as they may contain the words ‘risk’ and/or ‘feeding’.
The RCSLT, in collaboration with other organisations, has developed guidance on this topic. The guidance does not aim to be prescriptive regarding the use of any one particular term; instead it focuses on the principles for an effective decision-making process, rather than how to refer to it.
After extensive consultation the term agreed for use within this document is ‘eating and drinking with acknowledged risks’.
We recognise that, in practice, professionals will need to use language and terminology appropriate for the individual and for the context but encourage the use of this agreed term.
The purpose of this document is to guide healthcare professionals through the complex decision-making process to support adults when eating and drinking with acknowledged risks.
The aim is to provide a framework to facilitate a swift, consistent decision-making process respecting individual wishes and maximising quality of life.
The guidance aims to clarify the assessment, decision-making and documentation processes required in order to achieve person-centred, multidisciplinary and multi-agency care planning with clear methods of review for individuals.
It is not prescriptive but seeks to serve as guidance for adults with dysphagia across care settings.
While the Royal College of Physicians (RCP) document ‘Supporting people who have eating and drinking difficulties’ (2021) is the primary guidance for care and clinical assistance towards the end of life, this document will serve as an adjunct referring to the nuances within the decision-making process for adults eating and drinking with acknowledged risks irrespective of the stage or progression of their illness.
The decision-making process requires a person-centred problem-solving approach from the range of professionals involved in the individual’s nutritional management and care. This document was therefore compiled in consultation with an expert multidisciplinary working group.
These resources may help to deepen your understanding of and support your work in eating and drinking with acknowledged risks.
- Royal College of Physicians guidance: Supporting people who have eating and drinking difficulties (2021)
- British Geriatrics Society guidance: End of life care in frailty (2020)
- NICE guideline: Decision-making and mental capacity (2018)
Papers and articles
- Approaches to Eating and Drinking with Acknowledged Risk: A Systematic Review (2020)
- Complex Feeding Decisions: Perceptions of Staff, Patients, and Their Families in the Inpatient Hospital Setting (2016)
- Dysphagia after stroke and feeding with acknowledged risk (2016)
- Comfort feeding only: a proposal to bring clarity to decision-making regarding difficulty with eating for persons with advanced dementia (2010)
Lewisham and Greenwich NHS Trust
Note: If you or your service wish to reproduce the above leaflets of forms, please acknowledge the Lewisham and Greenwich NHS Trust using either:
- ‘Reproduced by kind permission of Lewisham and Greenwich NHS Trust’
- ‘Reproduced and amended by kind permission of Lewisham and Greenwich NHS Trust’
Guy’s and St Thomas’ NHS Foundation Trust
- Patient information leaflet (PDF): Making the decision to eat and drink with acknowledged risk of deterioration
- The FORWARD care bundle
Note: If you or your service wish to reproduce the above leaflet or care bundle, please acknowledge the Guy’s and St Thomas’ NHS Foundation Trust using either:
- ‘Reproduced by kind permission of Guy’s and St Thomas’ NHS Foundation Trust’
- ‘Reproduced and amended by kind permission of Guy’s and St Thomas’ NHS Foundation Trust’
They also kindly request that you contact them to let them know so they can keep track for the purpose of their project.
Feedback and suggestions
Please contact us if you have any suggestions or feedback on these pages, or if you have any resources you would be happy to share. We would particularly welcome case studies from SLTs and other professionals working in this area.