Eating and Drinking with Acknowledged Risk (EDAR)
A blog by Dr Olivia Farrer, Teaching Program Director and Lecturer in Nutrition and Dietetics, Flinders University, and ELDAC Postdoctoral Research Fellow; Jessica Zilujko Director, Food, Nutrition and Dining Advisory Unit, Chief Clinical Advisor Group and Dietitian; Rachel Leonard, Assistant Director, Food Nutrition and Dining Advisory Unit, Chief Clinical Advisor Group and Speech Pathologist.
As people face the challenges of aging and chronic illness, the opportunity to make informed decisions about their care is vital. This is important to preserving their dignity and identity.
Offering choice is important
The concept of dignity often links with the deeply personal choices faced by the individual and their families. Respecting a person’s right to choose ensures that their values and preferences are honored.
This empowers them to live their final months, weeks and days with a sense of control, enhancing quality of life and dying. In palliative care, eating and drinking familiar food and drink can bring a sense of normalcy and comfort. This can also connect patients to family and memories.
Challenges in maintaining usual eating and drinking
Maintaining previous long-term eating and drinking habits (including amounts) can be challenging for older people in palliative and/or aged care due to a combination of factors, including:
- changes in routine or eating setting
- a reduced appetite
- changes in taste and smell
- swallowing difficulties
- reduced digestive function
- poor fitting dentures
- lower attention to tasks
- side effects of medications (such as dry mouth, sedation, etc).
Loss of appetite and a decline in physical strength and energy can make eating and drinking less appealing, and in some instances unsafe, particularly during the ‘end of life’ period. The allied health team, including dietitians and speech pathologists, may suggest strategies such as texture modification to make eating and drinking safer and more appealing
In the last weeks or days of a person’s life, the role of nutrition isn’t a priority, and the focus may instead be on tastes of favourite or familiar foods. This is referred to as a ‘comfort care’ approach. This can be at odds with usual recommendations, particularly where regular texture food and drink may pose a risk of choking or aspiration.
Eating and Drinking with Acknowledged Risk (EDAR)
Choosing to eat and drink despite health risks is known as Eating and Drinking with Acknowledged Risk (EDAR). When regular food and drink poses a risk, it’s essential to have ‘dignity of risk’ or EDAR conversations alongside usual therapeutic recommendations. This ensures that the older person or their substitute decision maker can make informed decisions.
Aged care staff can work with allied health teams, including speech pathologists and dietitians, medical practitioners and the individual’s family to develop an EDAR plan.
This plan supports people who wish to eat and drink in ways that may pose health risks and includes:
- documented evidence of informed consent
- individualised risk mitigation strategies
- actions to take such as first aid should there be an adverse event.
The Charter of Aged Care Rights states that older people should “have control over and make choices about my care, and personal and social life, including where the choices involve personal risk.”
This principle is also in:
- the current Aged Care Quality Standards (requirement 1(3)(d))
- the proposed strengthened Aged Care Quality Standards (due for release in 2025).
The Aged Care Quality and Safety Commission has resources available for aged care workers on the importance of supporting older people’s rights to make informed decisions about their eating and drinking. These include:
You can also contact the Commission’s Food, Nutrition and Dining Hotline for further support on 1800 844 044, (9.00 am to 5.00 pm AEDT, Monday to Friday).
For further reading in ELDAC