Your Speech and Language Therapist (SLT) will have assessed your swallow by giving you a range of things to eat and drink.
They will have talked to you about your swallowing difficulties and the risk associated with eating and drinking.
About EDAR
EDAR means Eating and Drinking with Acknowledged Risk.
This is the term used to describe eating and drinking where there may be known risks of food and/or drink going down the wrong way. (By 'the wrong way' we mean into your windpipe, rather than your foodpipe.)
When this happens, it is called aspiration.
If your swallow is unsafe, you may decide to continue to eat and drink by mouth, even though there is a risk of aspiration.
Other known risks may be malnutrition and dehydration. Malnutrition means poor nutrition (usually not eating enough, or not eating the right food). Dehydration means not drinking enough fluids.
Sometimes Eating and Drinking with Acknowledged Risk is referred to as 'Risk Feeding' or 'Eating and Drinking at Risk'.
Making your decision about EDAR
The decision to continue to eat and drink with acknowledged risk is usually made by you. You make the decision with support from your family and friends, and from relevant medical professionals.
Your hospital Multi-Disciplinary Team (MDT) will give you all the information you need to make an informed decision. They can meet you and answer any questions you have.
You do not have to make the decision on your own, and we will give you time to think about your decision.
If you find it difficult to make decisions or are unable to make the decision yourself, your medical team will make the decision in your best interest. They will do this with the support of your:
- family and friends
- Lasting Power of Attorney (LPA) for Health and Welfare, or
- Independent Mental Capacity Advocate (IMCA).
They will always consider your wishes, preferences, cultural and ethical beliefs, when making the decision.
Your decision about EDAR does not have to be permanent.
If you decide you no longer want to eat and drink with acknowledged risk, you can discuss this with your doctor or GP. They will help you think about the available options.
Your Speech and Language Therapist (SLT) will also be able to help you.
Going ahead with EDAR
If you decide to go ahead with EDAR, a Speech and Language Therapist (SLT) will assess you.
They will recommend food and drink consistencies that suit you best. (Consistency means the texture of the food, ranging from a thin liquid to a crunchy solid food).
They will also recommend some strategies to help you when you are eating and drinking (see 'Useful tips', below). These strategies probably will not reduce the risk of aspiration but they may make eating and drinking easier for you to manage.
Your SLT will also talk to you about difficulties you might experience while eating or drinking. These might include:
- coughing when eating or drinking
- wet, gurgling-sounding breathing or voice
- food collecting in the mouth
- feeling short of breath.
(If you experience any of these, or if eating and drinking is difficult or distressing for you, you may want to stop for a while, and try again later.)
These eating and drinking difficulties might lead to:
- repeated chest infections
- weight loss
- dehydration
- frequent hospital admissions (if you and your medical team decide this is in your best interest)
- reduced life expectancy.
Useful tips when eating and drinking
It is always a good idea to follow the advice offered by your SLT when you eat and drink. Their advice may make swallowing more comfortable for you.
Their advice might include the following:
- sit fully upright, ideally in a chair
- eat and drink slowly
- take small sips or mouthfuls
- allow for extra time to swallow between mouthfuls
- cough to clear your throat after every few mouthfuls
- try to eat and drink small amounts often
- do not eat or drink if you feel tired
- if you wear dentures which are loose, it might be best to take them out and eat and drink without them
- avoid using straws or spouted beakers, unless your SLT recommends them for you.
Importance of good mouth care
Good mouth care is important for comfort. It also helps make sure that bacteria do not build up in your mouth. (Bacteria in your mouth can be carried to your lungs and lead to increased risk of chest infection.)
Good mouth care includes the following.
- Clean your mouth, teeth and tongue at least twice a day, and if possible, after you eat. You may need someone to help you with this.
- Clean your teeth and tongue with a toothbrush and toothpaste. You may find it helpful to buy low-foaming toothpaste.
- If you wear dentures, remove them and clean them carefully.
- Rinse and clear your mouth after brushing with toothpaste. Be careful not to swallow the water.
- During mouthcare, make sure you stand, or sit upright and lean forward. This will avoid toothpaste falling back into your throat.
- Swill mouthwash or water around your mouth to clean your gums. If you cannot do this safely, use a mouth care sponge swab to wipe around your gums. This will remove any remaining food residue or secretions from inside of your cheeks and the roof of your mouth. Use a fresh sponge each time.
- Keep your lips moisturised with lip balm or petroleum jelly (eg Vaseline).
- If you wear dentures, remove them when you are feeling sleepy (or going to sleep) or whenever you are lying on your back.
- If your dentures are loose, use denture adhesive to fit them.
Advanced care planning
Your medical team may also want to discuss how best to manage any future aspiration-related pneumonias. They can discuss this with you or your family and friends.
This advanced care planning will include future antibiotic treatment (eg for chest infections) and readmission into hospital (if needed).
More information
Contact information
Kingston Hospital Speech and Language Therapy (adult inpatients)