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Eating with Acknowledged Risk in Dementia — SCE Palliative Medicine MCQ

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ModerateNon-Malignant Palliative CareEating with Acknowledged Risk in DementiaSCE Palliative Medicine

An 82‑year‑old woman with advanced dementia develops recurrent aspiration pneumonia. A comfort‑focused care plan is in place. Speech and language assessment shows severe oropharyngeal dysphagia with aspiration on all consistencies. Despite this, she reaches for food when offered. What is the most ethical management of oral intake in this context?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Offer careful hand‑feeding with food she enjoys, accepting aspiration risk when goals are comfort‑focused

In advanced dementia with comfort‑focused goals, ‘eating and drinking with acknowledged risk’ (EDAR)—that is, offering careful hand‑feeding of preferred foods despite aspiration risk—is ethically appropriate. NICE NG97 recommends encouraging eating and drinking when wished for, and advises against routine enteral feeding in severe dementia unless for reversible issues; this supports avoiding PEG placement. EDAR policies (e.g., Hillingdon Hospitals) emphasise quality of life and patient preference even when safety cannot be fully assured. Alternatives are less appropriate: nil by mouth removes pleasure and autonomy; force‑feeding breaches dignity; PEG feeding offers no demonstrated quality‑of‑life or survival benefit in this setting; IV fluids alone neglect oral comfort and can be burdensome.

Reference: NICE NG97 (‘Encourage and support people…eat and drink…; do not routinely use enteral feeding’) and Hillingdon Hospitals NHS Trust EDAR policy