14 (3), 13-18. The SLP, in collaboration with the physician, can play a vital role as a member of the multidisciplinary healthcare team in assessing the nature of the dysph agia and the contributing factors, developing an individualized plan of care to effectively manage the behavior s and strategies to ensure optimal nutrition and hydration, providing caregiver education in safe swallow strat egies, and providing informed education regarding alternative nutritional systems. Dehydration may trigger increased combativeness and urinary tract infections. Patient Information Dementia Care: A Practical Guide to Swallowing Problems April 2014 www.uhcw.nhs.uk - 2 - Problems within the mouth It is important to rule out some common causes that may affect how a person is eating and drinking, for example, sore gums, ill … Fourth R eport of the Advisory Panel on Alzheimer’s Disease, 1992. Patients with dysphagia are at high risk for developing aspiration pneumonia as a result of food, liquid, or oral bacteria going into the lungs. It is difficult to distinguish the effect of normal aging from the effects of specific diseases or gradual degenerative changes. Alzheimer’s: Nutritional challenges. Prevalence of the Dual Diagnosis: Dysphagia and Dementia. Misinterprets or ignores the body signals of hunger and the need for food Offer liquids and water consistently throughout the day, as residents usually do not ask for a drink. When investigating the relationship between knowledge of the dysphagia and mealtime difficulties in different dementia stages and the importance of tailoring management to dementia stage, the Fisher's exact test showed a significant association for knowledge of dysphagia (p = 0.006), but not mealtime difficulties (p = 0.281). • Motor damage caused by dementia can disrupt airway closure and pharyngeal movement. intak e secondary to behavioral issues possibly related to dementia. In direct treatment, the clinician works directly with the resident, teaching him or he r compensatory strategies. If residents pour liquids over food, it may be necessary to provide them only when food is not present.< /TD>. Consider serving soups and hot cereals in a mug or soup bowl with handles. Choking is always a risk, even when healthy. 2003 Progress Report on Alzheimer’s Disease. The oral motor function will determine the pattern of mastication, which deteriorates in a predictable fashion with the progression of dementia. Many of t he residents in these statistics had a dementia diagnosis, which places them at higher risk for weight loss and dehydration. Anticipating end-of-life needs of people with Alzheimer’ s disease. Dysphagia and Dementia • Sensory damage can disrupt the process of bolus organization, mastication and Oral Transit. Common drug classes that reduce salivation include anticholinergic, antidepressant, and antipsychotic drugs. Does not use utensils correctly Limit the number of utensils. Provide cups and glassware that are easy to grasp. In: Kaplan M, Hoffman SB, eds. May behave disruptively because of room size and setup, type and size of tables, lighting, window glare, dishes, glassware, or utensils. Continue to try to encou rage eating with utensils if the resident’s skill level can be advanced. Stage 5: Moderate Dementia. Each of the swallow assessment components are individually reviewed below. Finucane TE, Christmas E, Travis K. Tube feeding in patients with advanced dementia: A review of the evidence. For many dysphagia patients, getting enough calories as well as vitamins and minerals becomes a tough challenge. Issues related to enteral feeding to sustain life in the end stage of dementia sho uld be discussed with the resident and family early in the disease process. Two key questions for the resident are: (1) “What are your problems with eating, drinking, an d swallowing?” and (2) “Why do you think you are having a problem with swallowing?” Besides valuable informatio n about the resident’s perception of the illness, you can get a sense of the resident’s overall cognitive statu s and ability to attend to and follow directions and learn new information. Waist pouches may help a pacer to keep his/her hands free so he/she can hold finger foods. From the earlier stages of forgetfulness and confusion to the end stage of impending death, provisions must be made by caregivers and professionals to encourage and maintain adequate nutrition for residents with dementia. If salivary flow is adequate, the oral cavity will appear wet; if hyposalivation is present, the oral cavity will become dry. The goal of the treatment planning session is to assist the patient and family in making informed decisions. These patients may exhibit changes in behavior during meals, changes in physiology of swallow, and changes in cognitive or language function that affect their ability to understand or implement treatment strategies. Many of the residents in these statistics had a dementia diagnosis, which places them at higher risk for weight loss and dehydration. Congress, Office of Technology Assessment. Administrators and other nursing home professionals will also benefit from a general understanding of the complexities of caring for these residents. Dysphagia can be caused by several different factors. Offer liquids and water consistently t hroughout the day, as residents usually do not ask for a drink. Offer visual cueing for boundaries by using pla ce mats to reduce interest in another’s meal. Conversations in Dementia Care for Speech-Language Pathologists Emily Hornback, MS, CCC-SLP, BCS-S 04/12/2019 Communication Sciences & Disorders Learning Objectives 1.Increase knowledge of cognitive staging of dementia and correlation to dysphagia. Symptoms of dry mouth (xerostomia) include mouth pain; difficulty chewing; difficulty swallowing; we ight loss; mouth infections; tooth decay; a dry, cracked tongue; bleeding gums; cracked corners of the mouth; b adly fitting dentures; and dryness in the eyes, nose, skin, and throat. Offer items such as breakfast bars, finger gelatin, and “edible containers" such as ice cream cones as options. Eats food pieces that are too big to swallow safely Assess food pieces for size, thickness, and consistency and make necessary adjustments. She often coughs when drinking liquids. Head and neck positioning. Need help with Short & Long Term Goals in Dementia Clients. To ensure reimbursement, goals and progress notes should reflect how speech-language treatment helps the patient to be more functional. The clinician will assess both the muscles associated with mastication and the p attern of mastication. Move-N Software for Independent/Assisted Living and CCRC communities provides all the high level Business Intelligence (BI) your organization needs to be successful in today’s evolving and highly competitive senior housing market. When addressing severe dysphagia in people with advanced dementia, the concept of “less is more” is frequently used. Available at: www.mayoclinic.com/invoke.cfm?id=HQ00618.Medicare Skilled Nursing Facility Manual: Specia l Instructions for MR of Dysphagia Claims (Rev. If dining at a restaurant, offer the menu and give the cueing needed to help with choices. Five or si x meals per day may be needed for residents who are unable to eat much at any one time if they become agitated when caregivers attempt to refocus them. The role of the SLP will change over time because of the progressive nature of the dementia disease process and its effect on swallowing function an d nutrition. To document skilled services, the clinician applies the tips listed below. Advisory Panel on Alzheimer’s Disease. When you are first diagnosed with dementia, your goals may be to preserve your ability to perform your daily activities. : American Occupational Therapy Association, 1992.Bayles KA, Tomoeda CK. The goal of assessment for an individual with dysphagia and dementia is to identify the nature of the dysphagia, identify the contributing factors, differentiate the physiologic impairment and/or cognitive dysfunction aspects, identify capacity for improved safety, and identify the potential benefit from skilled intervention. Methods We conducted 5 focus groups with 43 partici-pants (7 with early-stage dementia and 36 caregivers); 15 participants were Spanish-speaking. In what way may various textures and temperatures be introduced to inhibit spitting out or removal of food from the mouth? 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. : American Occupational Therapy Association, 1992.Bayles KA, Tomoeda CK. Our Return Policy. The clinician will: (1) visually inspect and assess ROM, stre ngth, and coordination of individual oral structures, including lips, tongue (anterior, middle, and posterior), and soft palate; and (2) assess the functional movement patterns required for the oral stage of swallowing, in cluding food bolus manipulation during chewing, cohesive food bolus formation, anterior-to-posterior transit of cohesive food bolus, and transfer or dropping of food bolus into pharynx. Improving Function in Dementia and Other Cognitive-Linguistic Disorders: Guide and Resource Book. Each patient and family will weigh quality of life and potential benefits and burdens differently. Once initiated, the swallow should occur briskly. Issue meal tickets or “credit cards, ” or have a bill filled out with a receipt that helps residents with “no money” to accept the meal. • Patient will tolerate a minimal cuff technique for __ minutes/hours/all day as determined by placement of a stethoscope to determine upper airway patency. Nov 7, 2017 - Long list of patient goals for the medical speech language pathologist. Staff should be alert to making a last-minute seating change. This will influence the nature of t he treatment program. Most often, the goals focused on improving quality of life for the person with dementia, followed by caregiver support goals (goals that help reduce caregiver stress or make caregiving as … The effect of progressive dementia, including Alzheimer’s disease, on swallowing function and independent eating/feeding will change over the course of the disease. Dysphagia (a difficulty swallowing) is common in people with dementia. 3, 11-22-00). The course of recovery or progressive decline found in t he diseases and surgical procedures linked to dysphagia vary widely. The jury is still out on how well cognitive therapy or training can help people with dementia. individuals with dementia with dysphagia 2. Sometimes a patient is satiated by just a few sips of water or ice chips. Yes, we are pleased to offer a Return Policy. An acceptable peer group is important. 597, Medicare Hospital Manual). Staff should be alert to making a last-minute seating change. Management of patients with dementia and dysphagia can be very complex. Examples of direct dysphagia treatment interventions include sensory stimulation, di et modification, muscle strengthening, ROM exercises, and caregiver training in feeding assistance. If overlooked, dysphagia can lead to a range of complications from weight loss and malnutrition to choking and aspiration pneumonia, which is a severe chest infection. Wou ld you like some?”, Demonstrates an inability to understand what is expected of him/her at mealtime. 597, Medicare Hos pital Manual). Therefore, the following information in the medical record should be sought: Resident/caregiver/nursing inte rview. All Rights Reserved. Patients with advanced dementia are among the most challenging patients to care for because they are often bedridden and dependent in all activities of daily living. < font color=”#509197″>Enteral Feeding and End-of-Life DecisionsMore than one-third of s everely cognitively impaired residents in U.S. nursing homes have feeding tubes. Offer environmental interventions to signal th e change to eating, including items altering the appearance of the table, such as a tablecloth, flowers, basket s for napkins, and place mats. Would you please try it and tell me what you think?”. With certificates in case management and quality management, she chairs the Quality Work Group for the California Association of Healthcare Facilities. Recent figures estimate that around 850,000 people are living with dementia in the UK (Alzheimer's Society 2017).). Sensory function. If so, the necessary information can be obtained from a caregiver or family member who is fami liar with the resident. Once the disease process contributing to t he dysphagia is identified, the clinician should determine the resident’s course of anticipated recovery or dec line. If so, the necessary information can be obtained from a caregiver or family member who is familiar with the resident. intake of calories; involving the resident in a facility hydration program; and evaluating the resident by PT/OT for appropriate positioning to expedite safe, effective swallow function and meal completion. These patients may exhibit changes in behavior during meals, changes in physiology of swallow, and changes in cognitive or language function that affect their ability to understand or implement treatment strategies. Dementia is a syndrome caused by a number of progressive disorders that affect memory, thinking, behavior, and the ability to perform activities of daily living (World Alzheimer Report, 2010).Alzheimer’s disease (AD) and other dementias currently affect more than 5 million Americans (Fargo and Bleiler 2014) and 747 thousand Canadians (Alzheimer Society of Canada, 2012), and the incidence is expected to exceed 7.1 millio… Offer high-protein and increased calorie foods. However, studies by Murphy and Lipman, as well as Finucane et al, conclude that there are no documented changes in nutritional status, pressu re sores, or other functional status following gastrostomy tube placement in these residents.1,2 Tub e feeding is not proven to prevent “wasting away,” and there is no survival benefit in residents with dementia who receive enteral feeding. NewRN1Student (New) I am having a very difficult time trying to come up with goals for my dementia client care plans. Journal of the American Medical Association 1999;282:1365-70. Washington, D.C.: U.S. Government Printing Office; NIH Publication No. I have a question regarding how tactile defensiveness is best treated when managing dysphagia in patients with dementia. (See Causes of dysphagia.) Dysphagia treatment can be divided into direct treatment and indirect treatment. DYSPHAGIA GOALSLONG TERM GOALS - SWALLOWING - Client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function on P.O. Often elderly residents with dementia eat with a knife because they pick it up with their dominant hand to cut their food (whether needed or not) and then forget to put it down to select a fork or spoon. Lift the item away from the table or lift the food from the plate to regain attention. The main sign for stage 5 dementia is the inability to remember major details such as the name of a close family member or a home address. This will influence the nature of the treatment program. Sometimes, nutrition may be provided intravenously as well. Symptoms of dry mouth (xerostomia) include mouth pain; difficulty chewing; difficulty swallowing; weight loss; mouth infections; tooth decay; a dry, cracked tongue; bleeding gums; cracked corners of the mouth; badly fitting dentures; and dryness in the eyes, nose, skin, and throat. Some physicians may recommend a nasogastric tube (NGT) to help deliver nutrition via the nose into the stomach. The Family Guide to Alzheimer's Disease Video Series provides an indispensable resource offering encouragement and instruction to those affected by Alzheimer’s Disease. The Dysphagia Cup is a special design cup for people who have difficulty swallowing. Provide cups and glassware that are e asy to grasp. As the population ages, hospital clinicians see more patients with dysphagia resulting from stroke, dementia, and Parkinson’s disease. Administrators and other nursing home professionals will also benefit from a general understanding of fork/spoon... Christmas e, Travis K. tube feeding in patients with advanced dementia: Best Practices for management. How well cognitive Therapy or Training can help people improve their lives and make necessary adjustments services the. 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Teaching him or her compensatory strategies create a sense of “ less is ”. And sugar may be burdensome to one patient may not be to another care plans how treatment. The following information in the presence of oropharyngeal dysphagia in individuals with dementia develop dysphagia some during! Low Return rates by 2:00 pm central Standard time Monday through Friday for in items.