152 Predicting outcomes of patients with dysphagia on a background of progressive frailty

<h3></h3> Palliative care is underutilised in older people living with frailty, partly due to difficulties in identifying patients likely to be in the last year of their life. Dysphagia is a common problem in older people and a poor prognostic indicator associated with an increased risk of aspiration pneumonia, morbidity and mortality. Management of dysphagia includes modifying diet and fluids or electing to eat and drink with an acknowledgement of risk (EDAR). Patients are faced with making a difficult decision between enhancing their life quality, by eating and drinking as they choose, versus prolonging life but with potentially less enjoyment of their last weeks, months or years. This decision may be made easier if those patients at a higher risk of an aspiration-related death were identified. Currently there are fifteen known risk factors which can confound decision-making and don’t reflect functional wellbeing. The Clinical Frailty Score is an established frailty scale which incorporates these factors and may be a better prognostic guide. This retrospective study reviewed the electronic records of 230 patients eating and drinking at risk, comparing 15 risk factors with the Clinical Frailty Score. Mortality was monitored over eighteen months and an aspiration risk calculation was completed to establish if these risk factors had been relevant in outcome prediction. Although risk of aspiration pneumonia contributes to a poor prognosis, results from this study suggest that a more general assessment of wellbeing is required if we are to identify which patients are most likely to tolerate EDAR. The interim results suggest that the risk factors applied were too numerous to predict the likelihood of an aspiration-related death in older people. Most older people died shortly after commencing EDAR due to other co-morbidities including frailty. Furthermore the Clinical Frailty Score may be a better predictor of outcomes in patients with dysphagia.