Dysphagia therapy in older people: weighing of aspiration risks against quality of life-a qualitative study

Definition of the problem In the treatment of geriatric patients with dysphagia who eat and drink, ethical conflicts arise especially with adaption of food consistencies. When weighing aspiration risk and quality of life against each other, the choice is often made in favor of beneficence-a minimization of aspiration risk-disregarding autonomy and nonmaleficence in the decision-making process. Aim Against this background, the goal of the study was the identification of relevant aspects in the decision process from the perspective of patients and their family members regarding the tradeoffs between safety and quality of life. Further aims were to test the interview guide and to develop hypotheses as a basis for further studies. Methods Geriatric patients (nx202f;= 8) with mild to severe dysphagia and at least one week of substantially adapted food as well as family members (nx202f;= 4) were questioned in semi-structured, problem-centered interviews. The evaluation was based on qualitative content analysis by Mayring. Results Problem-centered interviews with the new interview guide were found to be an appropriate method to record in detail how individuals experience the situation. A wide range of settings for risk versus quality-of-life decisions and ethical conflict situations that play a role in the context of food adaptation was reported. Three main categories were postulated: aspects indicating a higher risk tolerance, aspects indicating a lower risk tolerance, aspects indicating instable decisions. Conclusion The proposed categories give insight into the complex influences on risk/quality-of-life considerations of older people with dysphagia who eat and drink. The results can serve as a starting point for further studies and may contribute to the development of a framework for dietary decisions in dysphagia therapy for older people.