The RCP has published updated guidance on how to support people who have eating and drinking difficulties, particularly towards the end of life.
The newly updated guidance, produced by a multidisciplinary working party, aims to help healthcare professionals work together with patients, their families and carers to make decisions around nutrition and hydration that are in the best interests of the patient.
Over the past 2 decades there has been a dramatic change in patient populations in hospitals with an older demographic who have increasingly complex multiple long-term conditions, including cerebrovascular disease, degenerative neurological diseases and frailty. Difficulties with eating and drinking are common in these populations and the challenges they present to all concerned are considerable.
Decisions about nutrition and hydration and when to start, continue or stop treatment are some of the most challenging to make in medical practice. As well as weight loss and dehydration, problems with eating and drinking may be associated with very serious physical complications including episodic laryngeal obstruction, aspiration into the trachea and bronchi, secondary pulmonary infection, and bronchiectasis.
The guidance covers the factors affecting ability to eat and drink, strategies to support oral nutrition and hydration, techniques of clinically assisted nutrition and hydration, and the legal and ethical framework to guide decisions about giving and withholding treatment, emphasising the two key concepts of capacity and best interests.
Produced for medical and healthcare professionals, the guidance particularly supports those involved in caring for people who have eating and drinking difficulties, including gastroenterologists, ward nurses, geriatricians, dietitians, speech and language therapists, neurologists, palliative care teams, care home and community nurses.
The newly updated guidance has been endorsed by the British Association for Parenteral and Enteral Nutrition, British Dietetic Association, British Geriatrics Society, British Society of Gastroenterology, Dementia UK, Malnutrition Task Force (Age UK), National Nurses Nutrition Group, Royal College of Psychiatrists and the Royal Pharmaceutical Society.
Dr Aminda De Silva, chair of the working party, said: “We are really excited about this updated guidance on supporting people who are experiencing difficulties with eating and drinking. Its particular focus is on helping to steer through some of the complexities that can arise around nutrition and hydration towards the end of life and it aims to support healthcare professionals to work together with patients, their families and carers to make decisions that are in the best interests of the patient.
“We assembled a wide group of specialist experts in areas including neurology, dietetics, speech and language, gastroenterology, law, ethics, care of older people and palliative medicine to create these guidelines which now take into account recent changes in the law and Supreme Court rulings, particularly with application of the Mental Capacity Act 2005.
“Whether to start, continue or withdraw nutrition and hydration towards the end of life remains a contentious issue. We hope this document will guide an approach to finding a way through these difficulties that is legally sound, pragmatic and compassionate.”
Dr Hilda Hayo, Chief Admiral Nurse and CEO, at Dementia UK said: “Our population is ageing and increasingly living with complex long-term conditions, including dementia, which can cause difficulties with eating and drinking, particularly at end of life. This can be stressful and challenging for families and health professionals alike. We welcome this updated guidance that supports a multidisciplinary team approach to nutrition with good communication and shared decision-making with patients and their families.”
This guidance updates the previous Oral feeding difficulties and dilemmas published by the RCP/BSG in 2010.