Updated guidance from the Royal College of Physicians (RCP) should help physicians make challenging decisions about nutrition and hydration and when to start, continue or stop treatment in end of life patients.

The guidance has been produced by a multidisciplinary working party and aims to reflect the growing number of older patients in hospitals 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. 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.

Withdrawing nutrition towards the end of life remains a contentious issue

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), 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.

“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.”