{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:04:31Z","timestamp":1789146271514,"version":"build-2803163510"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T00:00:00Z","timestamp":1731456000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T00:00:00Z","timestamp":1731456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009098","name":"Japanese Respiratory Society","doi-asserted-by":"publisher","award":["2021"],"award-info":[{"award-number":["2021"]}],"id":[{"id":"10.13039\/501100009098","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000625","name":"Great Britain Sasakawa Foundation","doi-asserted-by":"publisher","award":["B149"],"award-info":[{"award-number":["B149"]}],"id":[{"id":"10.13039\/501100000625","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Dysphagia"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Eating and drinking are fundamental to life. However, older patients are often restricted with oral intake due to feared risk of aspiration. Eating and Drinking with Acknowledged Risks (EDAR) is an alternative process which enables comfort, dignity, and autonomy for these patients. While national guidance has been developed for EDAR in the UK, other ageing societies such as Japan do not have such guidance. To understand the perspectives and experiences of healthcare professionals regarding the complex decision-making process around EDAR we planned a mixed methods study comparing the two countries. This was the qualitative phase of the study. Twelve healthcare professionals (two doctors, nurses and speech and language therapists each in Japan and the UK) participated in semi-structured interviews on their roles and experiences related to EDAR in older adults. We analysed the data thematically, and three themes emerged: (1) healthcare professionals and healthcare systems, (2) priorities in decision-making and (3) relationship with family and patient. There were many similarities but also differences across the countries, in the setting, training and individual experience. Decision-making was shaped by a complex combination of individual, structural and cultural factors, which indicated in the Japanese culture a greater likeliness to defer clinical decision-making and to side with families\u2019 wishes. Healthcare professionals\u2019 experiences and attitudes towards EDAR differed depending on various factors related with the individual and environment. The next quantitative phase of our research aims to establish the mechanism to increase confidence around EDAR in professionals and training options.<\/jats:p>","DOI":"10.1007\/s00455-024-10765-4","type":"journal-article","created":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T23:09:45Z","timestamp":1731539385000},"page":"650-659","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Eating and Drinking with Acknowledged Risks (EDAR) in Older Adults: A Qualitative Study of the Experiences of Clinicians in Japan and the UK"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0913-3507","authenticated-orcid":false,"given":"Yuki","family":"Yoshimatsu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4652-3168","authenticated-orcid":false,"given":"Marianne","family":"Markowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6863-3099","authenticated-orcid":false,"given":"David G.","family":"Smithard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1137-9728","authenticated-orcid":false,"given":"Dharinee","family":"Hansjee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9723-3550","authenticated-orcid":false,"given":"Tadayuki","family":"Hashimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7109-6172","authenticated-orcid":false,"given":"Hiroyuki","family":"Nagano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3497-3137","authenticated-orcid":false,"given":"Ryan","family":"Essex","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,11,13]]},"reference":[{"key":"10765_CR1","doi-asserted-by":"crossref","unstructured":"Yoshimatsu Y, Smithard DG. A paradigm shift in the diagnosis of Aspiration Pneumonia in older adults. J Clin Med. 2022;11(17).","DOI":"10.3390\/jcm11175214"},{"issue":"5","key":"10765_CR2","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1016\/j.clnu.2015.09.011","volume":"35","author":"K Maeda","year":"2016","unstructured":"Maeda K, Koga T, Akagi J. Tentative nil per os leads to poor outcomes in older adults with aspiration pneumonia. Clin Nutr. 2016;35(5):1147\u201352.","journal-title":"Clin Nutr"},{"key":"10765_CR3","doi-asserted-by":"crossref","unstructured":"Smithard DG, Yoshimatsu Y, Pneumonia. Aspiration pneumonia, or Frailty-Associated Pneumonia? Geriatr (Basel). 2022;7(5).","DOI":"10.3390\/geriatrics7050115"},{"issue":"1","key":"10765_CR4","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1097\/SPC.0b013e32832531a5","volume":"3","author":"S Dalal","year":"2009","unstructured":"Dalal S, Del Fabbro E, Bruera E. Is there a role for hydration at the end of life? Curr Opin Support Palliat Care. 2009;3(1):72\u20138.","journal-title":"Curr Opin Support Palliat Care"},{"key":"10765_CR5","unstructured":"Hansjee D, Burch N, Campbell L, Crawford H, Crowder R, Garrett D et al. Eating and drinking With acknowledged risks: multidisciplinary team guidance for the shared decision-making process (adults).[Working Paper]. London, UK; 2021."},{"key":"10765_CR6","volume-title":"Supporting people who have eating and drinking difficulties. A guide to practical care and clinical assistance, particularly towards the end of life. Report of a working party","author":"Royal College of Physicians","year":"2021","unstructured":"Royal College of Physicians. Supporting people who have eating and drinking difficulties. A guide to practical care and clinical assistance, particularly towards the end of life. Report of a working party. London: RCP; 2021."},{"issue":"4","key":"10765_CR7","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1093\/ageing\/afz050","volume":"48","author":"P Sommerville","year":"2019","unstructured":"Sommerville P, Lang A, Archer S, Woodcock T, Birns J. FORWARD (feeding via the oral Route with acknowledged risk of deterioration): evaluation of a novel tool to support patients eating and drinking at risk of aspiration. Age Ageing. 2019;48(4):553\u20138.","journal-title":"Age Ageing"},{"issue":"4","key":"10765_CR8","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1093\/ageing\/afz027","volume":"48","author":"A Murray","year":"2019","unstructured":"Murray A, Mulkerrin S, O\u2019Keeffe ST. The perils of \u2018risk feeding\u2019. Age Ageing. 2019;48(4):478\u201381.","journal-title":"Age Ageing"},{"key":"10765_CR9","volume-title":"Addressing choices and preferences of individuals with dementia and swallowing difficulties","author":"D Hansjee","year":"2022","unstructured":"Hansjee D. Addressing choices and preferences of individuals with dementia and swallowing difficulties. Quebec, Canada: Alzheimer\u2019s Disease International (ADI), McGill University;; 2022."},{"key":"10765_CR10","doi-asserted-by":"publisher","first-page":"233372141666552","DOI":"10.1177\/2333721416665523","volume":"2","author":"A Miles","year":"2016","unstructured":"Miles A, Watt T, Wong WY, McHutchison L, Friary P. Complex feeding decisions: perceptions of staff, patients, and their families in the Inpatient Hospital setting. Gerontol Geriatr Med. 2016;2:2333721416665523.","journal-title":"Gerontol Geriatr Med"},{"key":"10765_CR11","doi-asserted-by":"crossref","unstructured":"Yoshimatsu Y, Hansjee D, Markowski M, Essex R. DG S. Decisions on eating and drinking in older adults admitted with Pneumonia. Eur Geriatr Med. 2024 Jun;15(3):771-775. doi: 10.1007\/s41999-024-00983-2.","DOI":"10.1007\/s41999-024-00983-2"},{"key":"10765_CR12","unstructured":"WHO Headquarters. World health statistics 2021: monitoring health for the SDGs, sustainable development goals 2021 [ https:\/\/www.who.int\/publications\/i\/item\/9789240027053"},{"key":"10765_CR13","unstructured":"Director-General for Statistics and Information Policy MoH, Labour and Welfare Government of Japan. Comprehensive Survey of Living Conditions [ https:\/\/www.mhlw.go.jp\/english\/database\/db-hss\/cslc-index.html"},{"key":"10765_CR14","doi-asserted-by":"crossref","unstructured":"Maksimenko A, Lyude A, Nishiumi T. Texture-modified foods for the elderly and people with dysphagia: insights from Japan on the current status of regulations and opportunities of the high pressure technology. 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Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77\u2013101.","journal-title":"Qualitative Res Psychol"},{"key":"10765_CR28","doi-asserted-by":"crossref","unstructured":"Yoshimatsu Y, Ohtake Y, Ukai M, Miyagami T, Morikawa T, Shimamura Y et al. Diagnose, treat, and SUPPORT. Clinical competencies in the management of older adults with aspiration pneumonia: a scoping review. Eur Geriatr Med. 2023.","DOI":"10.1007\/s41999-023-00898-4"},{"key":"10765_CR29","doi-asserted-by":"crossref","unstructured":"Yoshimatsu Y, Kragholm K, Clemmensen SZ, Melgaard D, Torp-Pedersen C, Smithard DG et al. The predictive value of anticholinergic drug exposure and the outcome of pneumonia: a Danish database study. Age Ageing. 2024;53(2).","DOI":"10.1093\/ageing\/afae012"},{"key":"10765_CR30","doi-asserted-by":"crossref","unstructured":"Yoshimatsu Y, Thomas H, Thompson T, Smithard DG. Prognostic factors of poor outcomes in pneumonia in older adults: aspiration or frailty? European Geriatric Medicine; 2024.","DOI":"10.1007\/s41999-023-00929-0"}],"container-title":["Dysphagia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00455-024-10765-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00455-024-10765-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00455-024-10765-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,7]],"date-time":"2025-06-07T05:50:07Z","timestamp":1749275407000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00455-024-10765-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,13]]},"references-count":30,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10765"],"URL":"https:\/\/doi.org\/10.1007\/s00455-024-10765-4","relation":{},"ISSN":["0179-051X","1432-0460"],"issn-type":[{"value":"0179-051X","type":"print"},{"value":"1432-0460","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,13]]},"assertion":[{"value":"18 April 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 September 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 November 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was provided by the Ethics Committee of Hashimoto Municipal Hospital in Japan (ID R2.10-1) and the Health Research Authority and Health and Care Research Wales in the UK (ID 321158). Written informed consent was obtained from each participant.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"Yuki Yoshimatsu is supported by the Japanese Respiratory Society Fellowship Grant (2021). This study was funded by the Great Britain Sasakawa Foundation (Butterfield Award, B149). The funders had no involvement in the study design or conduction. The authors received no other financial support for the research, authorship and publication of this article. The authors declare that they have no other competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}]}}