Assist your loved one with feeding if they require help or if instructed by your SLP. Feeding and swallowing strategies for the individual with dementia. Five recommendations – the 5 Fundamental Ms (Fig 1) – provide a framework that can help to reduce the risk of aspiration in these patients: MDT involvement; Maximising posture; Mealtime preparation; Mouth care; Medication management. Alternate small bites and sips. Providing your loved one with dementia with different types of visual, verbal, sensory and physical cues can be very effective during meals: For some people with dysphagia, the texture of a ‘normal’ diet can simply present too many risks, in which case, specific recommendations may be given by the SLP about making changes to the texture or consistency of food/liquids, to reduce the risk of choking and other dysphagia-related complications. Caregiver goals can also be long–term, like downsizing or short–term, like making a new diabetic meal by the end of the week. It can be difficult to spot a person having difficulty eating and drinking, because the warning ‘signs’ can be so subtle. Treatment for a swallowing disorder most likely will include a diet modification. Dysphagia is a common morbidity and cause of mortality following traumatic brain injury (TBI). Some might eat better if provided with smaller meals throughout the day, instead of three big meals at a time. Fruit is many times a mixed consistency food, with skin and juices blending, as may be ice cream and gelatins that start out as solids and melt to a thin liquid in the mouth. Sometimes, if the dysphagia becomes severe especially as the dementia progresses, artificial nutrition or tube feeding may be recommended for your loved one. This number increases as the disease severity progresses; with some degree of dysphagia found in close to 80% of institutionalized elderly diagnosed with dementia. Originally from Mumbai, India; Rinki currently practices in Rochester, New York as Healthpro Rehabilitation’s SLP Team Leader for the Western NY region. Provide education to both the person with dysphagia and the caregiver (ideally in multiple modalities). Despite this, there is a paucity of evidence demonstrating the efficacy of dysphagia management strategies and treatments in this population. According to the American Geriatrics Society Feeding Tubes in Advanced Dementia Position Statement: “When eating difficulties arise, feeding tubes are not recommended for older adults with advanced dementia. Austin: PRO-ED, Incorporated; 1998. Effectiveness of mealtime interventions on behavior symptoms of people with dementia living in care homes: a systematic review. Rather it represents a complex and multilayered condition that may impact on a person’s physical, emotional, and social life and carries significant burden surrounding functioning in everyday activities. Oropharyngeal dysphagia relates to nerves and weakened throat muscles, making it difficult to move food from the mouth to the throat and esophagus. Flashcards. Dysphagia treatment can be divided into direct treatment and indirect treatment. Your SLP may recommend some additional postural strategies to maximize your loved one’s swallow safety. Dysphagia can have many negative health consequences for people with learning disabilities, including dehydration, aspiration and asphyxiation. With a diagnosis of esophageal dysphagia, treatment may be more aggressive, including esophageal dilation, surgery or medications. The management of elderly patients with dysphagia requires the coordinated expertise of a number of health-care professionals, including the patients’ primary care physician, pulmonologist, speech and language pathologist, clinical dietician, occupational therapist, physiotherapist, nurse, oral hygienist, dentist, as well as the primary caregivers. Few studies have investigated dysphagia management among adults with learning disabilities. Regardless of a diagnosis, every individual deserves to ‘dine with dignity.’” It was originally a 2 hour CEU … 2014). PCP Management of Feeding/Swallowing Problems . DYSPHAGIA GOALSLONG TERM GOALS - SWALLOWING - Client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function on P.O. Efforts to enhance oral feeding by altering the environment and creating patient-centered approaches to feeding should be part of usual care for older adults with advanced dementia.”, Caring for a person with dysphagia and dementia presents a set of unique and difficult challenges. This site uses Akismet to reduce spam. Serve meals in quiet surroundings, away from the television and other distractions. Feed the person patiently, with a slow rate of intake. The dressing is the other concern, as with the milk and cereal scenario. Infants exposed to Zika virus (ZIKV) or diagnosed with congenital Zika syndrome (CZVS) may present dysphagia, regurgitation and other feeding difficulties. It is important to remember that dementia varies from person to person and these problems might look different in your loved one, depending on the type of dementia and stage of their disease process. Careful hand feeding should be offered because hand feeding has been shown to be as good as tube feeding for the outcomes of death, aspiration pneumonia, functional status, and comfort. Get 7 expert tips on managing dysphagia to keep seniors safe & healthy. Webinar Recording: Swallowing Exercises with Biofeedback, Webinar Recording: Why We Should Care About Pill Dysphagia, Managing Dysphagia in the ICU – Webinar Recording, The Gaffigans Raise Awareness of Swallowing Disorders, My Failed Swallow: A Disability, Not a Mindset, Caregiver’s Guide to Dysphagia in Dementia. A speech-language pathologist is a skilled professional who will identify the swallowing impairment and help determine the least restrictive solid food texture and liquid consistency that would be safest for oral intake. Oral feeding options for people with dementia: A systematic review. “With the right training, knowledge, and support, caregivers can enhance the quality of life of their loved ones with dementia. intake … Easterling ,C. S., & Robbins, E. (2008). Here is your 1-2-3 Action Plan. Dysphagia is difficulty in ... reaction to compensatory strategies, severity of dysphagia, cognitive status, respiratory function, caregiver support, and patient motivation and interest. Dysphagia is more than simply a physical difficulty. Client will demonstrate appropriate positioning of head and body during feeding to 75% accuracy with minimal clinician cueing. Terms in this set (30) Changes in healthcare mandate focus on outcomes - increasing cost of care - Patient Protection & Affordable Care Act of 2010 (obamacare) - demands for accountability across the boards. Regardless of the type, dysphagia can be debilitating to a loved one’s daily life, but is also treatable. Make sure all the food and liquid is swallowed before feeding the next bite. part 1. part 2. earn asha ceus! Another possible reason is that dysphagia management is commonly achieved by training the caregivers, and caregivers become the primary responsible for dysphagia care and management . Adequate nutrition and hydration must be preserved at all times during dysphagia treatment. Dysphagia can also lead to isolation and depression. ASPIRATION AND DYSPHAGIA IN CHILDREN WITH DOWN SYNDROME . For oropharyngeal dysphagia, a speech or swallowing therapist may be recommended by the doctor. Covid-19. Add to cart . Regardless of a diagnosis, every individual deserves to ‘dine with dignity.’” By being active, attentive, and willing to enforce taught strategies, caregivers will assist in helping their loved ones achieve their swallowing goals. “Caring for a person with dysphagia and dementia presents a set of unique and difficult challenges,” Desai wrote in an article for the National Foundation of Swallowing Disorders. With the right training, knowledge, and support; caregivers can significant enhance the quality of life of their … When we explore what goals are important for the person who has difficulty swallowing, we need to include the caregivers in the creation of these goals for therapy. intake without overt signs and symptoms of aspiration for the highest appropriate diet level • Client will utilize compensatory strategies with optimum safety and efficiency of swallowing function on P.O. The patient will complete an instrumental evaluation (MBSS or FEES) within 1 week in order to evaluate swallowing safety. Whear R, Abbott R, Thompson-Coon J, Bethel A, Rogers M, Hemsley A, et al. The length of acute care hospitalization, however, has decreased over time with many individuals weak and frail upon admission for rehabilitation and possibly with continued dysphagia upon discharge. The audio in these two episodes is from a live, video CEU event with SpeechTherapyPD.com. You can follow her Medical SLP updates on Facebook and Twitter or reach out to her at firstname.lastname@example.org. While some of the symptoms cannot completely be erased, especially if neurological, early detection and treatment can help minimize the lasting effects. If a caregiver has more than one goal, make sure they are splitting their time evenly between them. These types of short-term measures are good to help someone with swallowing problems recover from acute illnesses such as a urinary tract infection. Simplify, by serving one or two dishes at a time. Required fields are marked *. To document skilled services, the clinician applies the tips listed below. This is mainly caused by neurological disorders or cancer, causing choking, gagging or coughing when a loved one attempts to swallow. They may need to eat using compensatory postures or techniques such as turning or tilting their head in a certain direction. to help improve oral intake. Watching a loved one lose interest in eating or drinking, choking, or having difficulty swallowing can be heartbreaking. In the next phase, the dementia care managers helped an additional 101 people with dementia and their caregivers set care goals. ... How-to – “wording” your goals or writing them clearly. Eating and chewing slowly is an important technique for those already diagnosed, and a lesson in patience for loved ones, albeit a lesson well worth the time. Covid-19. Other types of dementia include Vascular Dementia, Dementia with Lewy Bodies and Frontotemporal Lobe Dementia. She has presented at national and international conferences on topics related to adult dysphagia and written numerous articles for leading SLP blogs and magazines. Swallowing disorders affect each person differently and a specialist will look at those particulars to come up with a specific treatment plan. Achievement of these goals can promote independence and reduce anxiety, as well as improve interactions between the client and clinician or caregiver. A caregiver can help with the embarrassment factor, especially in public settings, by planning ahead, whether it’s calling the restaurant or talking to the party host. Some of these include: Physical problems: inability to hold or use utensils properly, inability to maintain proper posture during meals, weakness, lack of activity, tremors (commonly seen in Parkinson’s disease), Sensory problems: inability to recognize food or drinks, inability to gauge food temperature, reduced awareness of hunger and thirst, changes in smell and taste, problems in vision, Environmental problems: excessive noise, too much visual stimulation, poor lighting, unpleasant odors, or uncomfortable room temperatures leading to increased confusion, Poor oral hygiene: eating may be painful due to the person having a dry mouth, gum disease, mouth ulcers, poor oral hygiene, poor dentition, missing or ill-fitting dentures, Medication side effects: new medications and dosage changes may affect appetite as well as impact the person’s ability to swallow effectively, Communication and cognitive problems: inability to express needs and food preferences, difficulty following instructions to participate in meals, difficulty remembering to eat, increased confusion leading to unwanted behaviors during meals. , pneumonia accounts for nearly 70 % of the week role in physical and emotional.... 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