Healthcare professionals’ experiences and thoughts on eating and drinking with acknowledged risks in older adults: a comparison of Japan and the UK

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PURPOSE: Older adults are commonly restricted of oral intake due to concerns of aspiration. Eating and drinking with acknowledged risks (EDAR) is an alternative pathway that facilitates comfort, dignity and autonomy. However, EDAR decision-making is difficult, with guidance only existing in the UK, and support not readily available. This study was the third in a mixed-methods project aiming to understand how to develop EDAR further whilst providing clinicians with optimal support. This study aimed to reveal the factors that shape confidence in healthcare professionals regarding EDAR decision-making. METHODS: We performed a survey regarding the experiences of healthcare professionals in Japan and the UK with EDAR in older adults. We developed the survey based on themes extracted from our previous qualitative study. RESULTS: There were 1452 responses (1058 Japanese, 394 UK). Confidence towards EDAR was higher in UK-based respondents (β = 2.358, SE = 0.137, P < .001), with greater years of experience (β = 0.028 per year, SE = 0.005, P < .001), higher rate of clinical work related to EDAR (β = 0.341, SE = 0.022, P < .001), a more involved role in the decision-making, and being clinicians who are not doctors. Similar results were observed regarding likeliness to support EDAR, likeliness to acknowledge perceived benefits, and lower levels of difficulty in undertaking EDAR. Framework (such as guidelines/protocols) and education were ranked to be most beneficial in both countries. CONCLUSIONS: Confidence towards EDAR-decision making was shaped through multiple internal and external factors. Acknowledging these allows us to identify areas in need and provide culturally adapted support, leading to improved experiences in patients, families and healthcare professionals.

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