In law, we are obligated to provide basic care, which is a list of procedures considered essential to keep an individual comfortable. The offer of oral nutrition and hydration are listed within basic care. When the individuals swallowing function is impaired by the stroke, taking a risk management approach to ensure the best quality of life can cause some healthcare professionals to feel uncomfortable, especially if they are involved in assisting the person with eating and drinking. Eating and drinking for comfort with or without acknowledged risks should take steps to avoid aspiration and distressing symptoms such as choking and persistent coughing, whilst attempting to optimise comfort.
The key elements of eating and drinking for comfort
Select each for more information:
1. Shared Objective
Everyone involved in providing care should know that the focus is on providing comfort and not ensuring adequate nutrition and hydration. It should never involve:
- Force feeding
- Syringe feeding
Everyone involved should know that the decision has been made taking full account the patient’s capacity to make a decision about feeding and with full discussion within the multi-disciplinary team and family.
2. Close monitoring
Swallowing ability will change over time and be highly variable due to increasing fatigue. Refusal or inability to take anything orally on one occasion should not result in no further offers. Good mouth care is essential and should be provided before and after all offers of oral intake. How the individual responds to oral care can be an indicator of how likely they are to initiate swallowing. Speech and language therapists can assist in monitoring swallowing ability.
3. Comfort swallowing care plan
- Dietary modifications of food and fluid
- Ask about favourite tastes don’t force or fuss about eating
- Food consistencies which will not pose a choking risk
- Oral feeding strategies
- Thermal (offering different temperatures of foods) or taste stimulation (using a variety of tastes)
- Positioning
- Safe positioning for eating whilst ensuring limited discomfort
- Remain sitting in upright position for a period after feeding
- Things to look out for and know when to stop
- Monitor breathlessness
- How to assist in coughing or clearing respiratory congestion e.g. repositioning, suction
- Emergency procedures in case of obstruction of airway
- Oral care guidance
- Keep mouth moist – sips, oral sponges, ice chips
- Include lip care – use lip balm
4. Family involvement
Families may want to assist with mouth care and helping the person to eat and drink for comfort. Observation and direct instruction are best to support families become more involved in care. Ensure everyone is up-dated regularly and aware of any changes. Good communication with the person, family and carers is essential to effectively manage eating and drinking strategies.
Page last reviewed: 16 Jan 2023
