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Eating and Drinking with Acknowledged Risk (1025)

Warning

A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.

Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.

If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.

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Editorial Information

Last reviewed: 21/08/2026

Next review date: 31/08/2029

Author(s): Alison Gray.

Version: 2

Approved By: Board Clinical Governance Forum

Document Id: 1025

References

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British Geriatrics Society (2018) Dysphagia management for older people towards the end of life. London: British Geriatrics Society. Available at:British Geriatrics Society Dysphagia Management Guide(Accessed: 12 August 2026).

Clarke, G., Harrison, K., Holland, A., Kuhn, I. and Barclay, S. (2013) ‘How are treatment decisions made about artificial nutrition for individuals at risk of lacking capacity? A systematic literature review’, PLoS ONE, 8(4), e61475. Available at:How are Treatment Decisions Made about Artificial Nutrition for Individuals at Risk of Lacking Capacity? A Systematic Literature Review | PLOS One(Accessed: 12 August 2026).

Department of Health and Social Care (2008) End of Life Care Strategy: promoting high-quality care for adults at the end of their life. London: Department of Health and Social Care. Available at:End of Life Care Strategy(Accessed: 12 August 2026).

General Medical Council (2024) Treatment and care towards the end of life: good practice in decision making. London: General Medical Council. Available at:Treatment and care towards the end of life: good practice in decision making(Accessed: 12 August 2026).

Gillick, M.R. (2000) ‘Nutrition in advanced dementia: Tube-feeding or handfeeding until death?’, New England Journal of Medicine, 342(3), pp. 206–210. Available at:ResearchGate article(Accessed: 12 August 2026).

Langmore, S.E., Grillone, G., Elackattu, A. and Walsh, M. (2009) ‘Disorders of swallowing: Palliative care’, Otolaryngologic Clinics of North America, 42(1), pp. 87–105. Available at:Disorders of Swallowing: Palliative Care - Otolaryngologic Clinics of North America(Accessed: 12 August 2026).

Lennard-Jones, J.E. (2000) ‘Ethical and legal aspects of clinical hydration and nutritional support’, BJU International, 85(4), pp. 398–403. Available at:Ethical and legal aspects of clinical hydration and nutritional support - Lennard‐Jones - 2000 - BJU International - Wiley Online Library(Accessed: 12 August 2026).

Li, I. (2002) ‘Feeding tubes in patients with severe dementia’, American Family Physician, 65(8), pp. 1605–1611. Available at: American Family Physician article (Accessed: 12 August 2026).

Mitchell, S.L., Kiely, D.K. and Lipsitz, L.A. (1997) ‘The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment’, Archives of Internal Medicine, 157(3), pp. 327–332. Available at:The Risk Factors and Impact on Survival of... : Archives of Internal Medicine(Accessed: 12 August 2026).

National Institute for Health and Care Excellence (NICE) (2006) Dementia: supporting people with dementia and their carers in health and social care (CG42). London: NICE. Available at: NICE CG42 Dementia Guideline (Accessed: 12 August 2026).

National Institute for Health and Care Excellence (NICE) (2015) Care of dying adults in the last days of life (NG31). London: NICE. Available at:Overview | Care of dying adults in the last days of life | Guidance | NICE(Accessed: 12 August 2026).

Office of the Public Guardian (2020) Mental Capacity Act Code of Practice. London: The Stationery Office. Available at:Mental Capacity Act Code of Practice(Accessed: 12 August 2026).

Palecek, E.J., Teno, J.M., Casarett, D.J., Hanson, L.C., Rhodes, R.L. and Mitchell, S.L. (2010) ‘Comfort feeding only: A proposal to bring clarity to decision-making regarding difficulty with eating for persons with advanced dementia’, Journal of the American Geriatrics Society, 58(3), pp. 580–584. Available at:Comfort Feeding Only : Journal of the American Geriatrics Society(Accessed 17 August 2026)

Royal College of Speech and Language Therapists (RCSLT) (2021) Eating and drinking with acknowledged risks: Multidisciplinary team guidance for the shared decision-making process (adults). London: Royal College of Speech and Language Therapists. Available at: RCSLT EDAR multidisciplinary guidance (Accessed: 12 August 2026).

Royal College of Physicians (2021) Supporting people who have eating and drinking difficulties: A guide to practical care and clinical assistance, particularly towards the end of life. Report of a working party. 2nd edn. London: Royal College of Physicians. Available at:Supporting people who have eating and drinking difficulties(Accessed: 12 August 2026).

Royal College of Physicians and British Society of Gastroenterology (2010) Oral feeding difficulties and dilemmas: A guide to practical care, particularly towards the end of life. London: Royal College of Physicians. Available at:Oral feeding difficulties and dilemmas(Accessed: 12 August 2026)

Scottish Government (2018) Practising Realistic Medicine: Chief Medical Officer for Scotland annual report. Edinburgh: Scottish Government. Available at:Practising Realistic Medicine(Accessed: 12 August 2026).

Sommerville, P., Lang, A., Nightingale, S. and Birns, J. (2016) ‘Dysphagia after stroke and feeding with acknowledged risk’, British Journal of Neuroscience Nursing, 12(4), pp. 162–170. Available at:Dysphagia after stroke and feeding with acknowledged risk | British Journal of Neuroscience Nursing(Accessed: 12 August 2026).

Sommerville, P., Lang, A., Harbert, L., Archer, S., Nightingale, S. and Birns, J. (2017) ‘Improving the care of patients feeding at risk using a novel care bundle’, Future Healthcare Journal, 4(3), pp. 202–206. Available at:Improving the care of patients feeding at risk using a novel care bundle - ScienceDirect(Accessed: 12 August 2026).