Use simple words. The brave, new LTC world: Are you on board? The jury is still out on how well cognitive therapy or training can help people with dementia. May behave disruptively because of room size and setup, type and size of tables, lighting, window glare, dishes, glassware, or utensils. In the middle stage, the individual with dementia may be unable to sit long enough to eat, yet at this stage may require an additional 600 calories per day because of wandering and motor restlessness. Thus, adequate nutrition and hydration in a resident with dementia is a central concern for all members of the family and healthcare team. Many of t he residents in these statistics had a dementia diagnosis, which places them at higher risk for weight loss and dehydration. Emily Stuart, apetito Dietitian discusses Dysphagia in dementia patients: Nearly 50 million people are currently living with dementia, a number which is expected to increase to 131.5 million by 2050. Offer items such as breakfast bars, finger gelatin, and “edible containers" such as ice cream cones as options. Therefore, the following information in the medical record should be sought: Resident/caregiver/nursing inte rview. When asking questions about food choices, use “either/or” questions rather than “yes/no” questions, which could lead to “nos” and not eating. Sits too close to others or someone he/she dislikes Be aware of residents’ preferred tablemates. Specific components of the initial assessment include chart review, resident/caregiver/nursing interview, sensory function, head and neck positioning, oral motor skills, pattern of mastication, salivation, and laryngeal elevation. Alternate hot and cold foods to help trigger a swallow.Establish a policy so that honey and sugar may be used on food, if medically appropriate, as these entice res idents to eat. Mouth care; 5. This is one reason a facility can benefit from the involvement of a speech-language pathologist (SLP). individuals with dementia with dysphagia 2. 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. Co mmon drug classes that reduce salivation include anticholinergic, antidepressant, and antipsychotic drugs. Sits too close to others or someone he/sh e dislikes. Would you please try it and tell me what you think?”. Serve gravies and sauces in a side dish for dipping. write functional and measureable goals that provide evidence of skilled care; Malnutrition, Dehydration and Dysphagia in Individuals With Dementia Michelle Tristani, MS, CCC-SLP. The clinician will assess both the muscles associated with mastication and the p attern of mastication. The progressive deterioration in the mastication patte rns below reflects a transition from higher level reflex integration to lower level reflex integration during t he course of dementia: < b>Salivation. Once the disease process contributing to the dysphagia is identified, the clinician should determine the resident’s course of anticipated recovery or decline. 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. The question then is whether the resident demonstrates dysphagia secondary to a physi ologic deficit and/or a cognitive deficit. Be Vigilant. Make sandwiches with anything that will hold together. Percutaneous endoscopic gastrostomy does not prolong survival in patients with dementia. The Hand to Hand Mug is a special design cup for people who have difficulty grasping or holding a cup. Crescent shape provides support for cervical alignment without forward flexion. We love to help people improve their lives and make it easier for them. Rockville, Md. Square tables create a sense of “my space”; round tables create the illusion of someone eating off another’s plate. Murray J. Manual of Dysphagia Assessment in A dults. Because we offer only high-quality merchandise, we have remarkably low return rates. dysphagia or difficulty in swallowing. A table for one or two may be needed if a resident with dementia is experiencing hostility or paranoia. To elicit patient-centered goals for dementia care, we conducted a qualitative study using focus groups of people with early-stage dementia and dementia caregivers. Growing numbers of patients with dementia and dysphagia are being admitted to acute medical wards with complex problems including reversible or transient medical conditions, acute stroke or other neurological aetiologies. Behaviors in Dementia: Best Practices for Successful Managemen t. Baltimore: Health Professions Press, 1998.Mayo Clinic. E xamples of indirect dysphagia treatment interventions include addition of sweetener to food items (if only swee t taste receptors remain); use of alternative nutritional systems, such as enteral feeding; and/or oral care/se nsory stimulation provided by nursing. Overall, dementia is a long-term illness, and most people live from four to 10 years after being diagnosed. Recent figures estimate that around 850,000 people are living with dementia in the UK (Alzheimer's Society 2017).). 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. Clorox Healthcare offers a wide range of solutions (from comprehensive surface disinfection to advanced technologies) to help prevent and stop the spread of infections. Takes another resident’s food Offer visual cueing for boundaries by using place mats to reduce interest in another’s meal. The Dysphagia Cup is a special design cup for people who have difficulty swallowing. Orders received by 2:00 pm Central Standard Time Monday through Friday for in stock items will ship within 24 hours. individuals with dementia with dysphagia 2. The components of laryngeal elevation would include the speed of laryngeal elevation, the movement of the structures involved, and the int egrity of their movement. Inform them tha t the meal is part of the “club” membership; therefore, it is required that they eat dinner at the club. SKILLED INTERVENTION FOR A COMMON-AND T ROUBLING-DISORDER. T he clinician will also assess laryngeal elevation during dry and/or bolus swallows. sensory stimulation and/or integration, such as increasing texture variation (dry crackers or crisp cookies), increasing mouth sensation, and facilitating mastication pattern; diet management (as prescribed), development of an individualized plan of care/functional maintenance program (FMP), and caregiver training for implementation. When asking questions about food choices, use “either/or” questions rather than “yes/no” questions, which could lead to “nos” and not eating. • Due to Sensory and Motor Damage dementia patients … Therefore, the following information in the medical record should be sought: Two key questions for the resident are: (1) “What are your problems with eating, drinking, and swallowing?” and (2) “Why do you think you are having a problem with swallowing?” Besides valuable information about the resident’s perception of the illness, you can get a sense of the resident’s overall cognitive status and ability to attend to and follow directions and learn new information. Five or six 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. Dementia UK (2016) Tips for Eating and Drinking with Dementia. Although there are few studies of the incidence and prevalence of dysphagia in individuals with dementia, it is estimated that 45% of institutionalized dementia patients have dysphagia. To send comments to the author and editors, please e-mail [email protected] To order reprints in quantities of 100 or more, call (866) 377-6454. • Patient will manage oral secretions with (min/mod/max) cues for lip closure and/or swallowing. I have a care plan for imbalanced nutrition: less than body requirements and now I need a plan for something other than physiological. Available at: www.mayoclinic.com/invoke.cfm?id=HQ00618.Medicare Skilled Nursing Facility Manual: Specia l Instructions for MR of Dysphagia Claims (Rev. The SLP’s goal is the same as Medicare’s number one goal in these residents: “facilitating and mai ntaining safety for the resident during swallowing and p.o. 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. Available at: www.alzheimers.org/pr01-02.National Institute on Aging, Alzheimer’s Diseas e Education & Referral Center. Journal of the American Medical Association 1999;282:1365-70. Pours liquids onto foods If residents pour liquids over food, it may be necessary to provide them only when food is not present. Ninety percent of people who have dementia are likely to experience problems with chewing or swallowing at some point in their illness. But as the disease progresses, your goals may shift and your preferences for your care may shift with them. Congress, Office of Technology Assessment. There are no products to list in this category. If the resident cannot do this, it is important to provide caregivers with adequate information regarding available treatment options and the consequences related to nutritional intake. Sometimes, nutrition may be provided intravenously as well. 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. Establish a policy so that honey and sugar may be used on food, if medically appropriate, as these entice residents to eat. Reinforce with simple one-step directions using visual and gestural cueing. Square tables provide better definition of territory than round t ables. Has an inability to attend to the task of eating, limiting the meal from being consumed ent irely. Assess food pieces for size, thickness, and consistency and make necessary adjustments. 14 P. 18. In: Kaplan M, Hoffman SB, eds. The clinician will also assess laryngeal elevation during dry and/or bolus swallows. DYSPHAGIA GOALSLONG TERM GOALS - SWALLOWING - Client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function on P.O. During feeding, she pockets food in her cheeks and spits it out. When you are first diagnosed with dementia, your goals may be to preserve your ability to perform your daily activities. Is unable to make choices if too much food or too man y containers are present at one time, Serve one course at a time so that the necessity of making choices is limited and there are fewer distractions; when appropriate, allow menu selection and the choi ce between two or three main courses. This is a serious respiratory infection that is common in seniors with or without dementia. Inform them that the meal is part of the “club” membership; therefore, it is required that they eat dinner at the club. Use of this website is subject to our Privacy Policy and Terms of Use. Glare from windows or lights can create agitation; if feasible, encourage natural sunlight. Demonstrates an inability to understand what is expected of him/her at mealtime Establish the same routine at each meal. Use terminology that reflects the clinician's technical knowledge. Some residents prefer or demand the same seat every time and will become aggressive if someone else sits “in my seat.” Consider using name cards, or remove the resident’s s eat until just before he/she arrives at the table. Use multisensory cueing with frequent pointing. According to the National Institutes of Health, swallowing problems occur in about 45% of those have been diagnosed with Alzheimer’s and other dementias. Has difficulty discriminating bound aries between items. Use multisensory cueing with frequent pointing. 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). Enteral Feeding and End-of-Life Decisions. Help the family understand that what they are seeing is part of the natural course of advanced dementia and/or end-stage-illness. Once initiated, the swallow should occur briskly. Quality of life encompasses concepts such as the influence of psychosocial, cognitive, religious, or other spiritual influences. Goals for nursing a person with dementia Appropriate goals for caring for a person with dementia in a community or hospital setting include: u Develop a relationship with the person based on empathy and trust. Staff should be alert to making a last-minute seating change. MayoClinic.com, October 2003. Each of the swallow assessment components are individually reviewed below. These include damage to the parts of the brain responsible for controlling swallowing. 10 No. 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. Dehydration may trigger increased combativeness and urinary tract infections. What may be burdensome to one patient may not be to another. ‘Dementia’ is an umbrella term covering a range of neurodegenerative pathologies and is diagnosed when there is a significant impairment in at least one cognitive domain such as language, memory, visuospatial function, or executive function (American … intake secondary to behavioral issues possibly related to dementia. Dysphagia can be a result of behavioral, sensory, or motor problems (or a combination of these) and is common in individuals with neurologic disease and dementia. In the late stage, the individual with dementia does not have intact oral motor skills for chewing a nd swallowing, thus becoming subject to malnourishment and “wasting away.”. Strategies for managing some of these changes are summarized in the table. It is imperative that the SLP, as well as the director of nursing and other key members of the c aregiving team, have a solid understanding of dysphagia and appropriate treatment and management techniques spe cific to the disorder. Establish the same routine at each meal. Dysphagia and Dementia • Sensory damage can disrupt the process of bolus organization, mastication and Oral Transit. A 74-year-old man with Alzheimer’s dementia presents with urinary tract infection (UTI), hypovolemia, and hypernatremia. u Maintain a safe environment for the person, yourself and other staff. Indicate the rationale (how the service relates to functional goal), type, and complexity of activity. One of the most common obstacles to those with dementia is a swallowing problem, or dysphagia. Says someone is seated “in my place” Some residents prefer or demand the same seat every time and will become aggressive if someone else sits “in my seat.” Consider using name cards, or remove the resident’s seat until just before he/she arrives at the table. Offer snacks between meals and before bedtime. sensory s timulation and/or integration, such as increasing texture variation (dry crackers or crisp cookies), increasing mouth sensation, and facilitating mastication pattern; diet management (as prescribed), development o f an individualized plan of care/functional maintenance program (FMP), and caregiver training for implementatio n. An FMP is a detailed program of strategies and instruction carried out by the caregiver that maximizes resid ent skills to maintain the highest level of functional independence; providing oral care from nursing before meals with a citric swab to increase salivation; offering the resident six small meals daily; offering the resident calorie-loaded finger foods throughout the day to increase p.o. Students General Students. 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. intake without overt signs and symptoms of aspiration for the Assessment con siders both habitual body position and habitual head position. 1. 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. Difficulties may include the person chewing continuously or holding food in their mouth. Some patients may be ... the patient’s prognosis and the specific goals of … Reduce Dementia-related Swallowing Problems Swallowing Can Be A Killer. Improving Function in Dementia and Other Cognitive-Linguistic Disorders: Guide and Resource Book. 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