Dysphagia/end stage dementia

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Specializes in LTC,Hospice/palliative care,acute care.

I am struggling with our speech pathologists and some of their recommendations for our late stage dementia residents.We work very hard to educate these family members regarding the expected progression of the disease through frequent advance life care planning.A large portion of my time is spent talking about dysphagia,artificial feeding and fluid resuscitation and our goal of continuing to offer foods and fluids as tolerated.No weekly weighs,no shoving food down these folk's throats.Most of the loved ones "get it". I talk about various techniques for feeding such as alternating flavors and temps,positioning,pleasant surroundings and also encourage the family to bring in anything the resident may have enjoyed or is asking for. I have BIG problem with using ice on a resident's mouth to stimulate an oral response.I don't believe that is a very pleasant sensation for an end stage dementia resident.Am going to try it on some co-workers to see what they think

I have a BIG problem with using a baby spoon,that's a dignity issue for me.

I have a BIG problem with loudly and repeatedly instructing the resident to chew,swallow,swallow,tuck,swallow...Just does not seem pleasurable.

I'm looking for some opinions here ,I don't know if this is just an emotional trigger for me or a valid concern.I appreciate any and all comments.

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Specializes in Emergency Medicine.

The speech pathologists are doing things based on tried and true research.

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Specializes in Acute Care, Rehab, Palliative.

Why on earth would a baby spoon be a problem?

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Specializes in LTC,Hospice/palliative care,acute care.

Using a baby spoon to shove a small amount into a resident with a small (voluntary) oral opening is a dignity issue for me.And it's a fine, line between coaxing and force feeding.I know these are "tried and true" techniques but I am talking about comfort care residents in LTC.

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Specializes in Urology, HH, med/Surg.

If these are true 'comfort care' patients, why are speech therapists being consulted?

As a hospice nurse, educating the family on natural decline of appetite & thirst was a big hurdle. If the family understands (as it sounds) then ST wouldn't be needed?

As far as the baby spoon- if the patient wants to eat & that is a good way to get them small bites, that shouldn't be a big deal (though I do understand your point)

I once fed an ALS pt by sticking a straw in ensure & giving her really small 'bites' of what could be retained in the end because the muscles around her mouth didn't work anymore- no sucking ability or ability to put lips around spoon/fork.

I would imagine the real issue is a matter of desire for food or drink? Maybe explain that to ST?

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Specializes in LTC,Hospice/palliative care,acute care.

All therapies ,consults etc continue on comfort care here and the goals shift to comfort and dignity.It's our bridge to hospice care.I get that there is a certain amount of revenue involved,that drives the bus.I feel they are just too aggressive.We've had issues with several of them in the past and I am trying to decide if that has colored my opinion of everything they do now or are my concerns legitimate....Don't tell me to smear high protein pudding and crushed meds around someone's mouth so they will lick it off.... That's just so wrong....

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Specializes in Urology, HH, med/Surg.

Oh my. I would have more problems with the smearing around the mouth than a baby spoon as far as the dignity concerns go!!

And yes, reimbursement will always win. And explains why ST comes. I don't know much about what they have to do to 'justify' their services, but does their plan have to be implemented? Or--how to say this correctly-- implemented to a high degree? Eg: maybe a tiny dot of pudding on the lip & then report pt just doesn't have much of an appetite??

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Specializes in Urology, HH, med/Surg.

Oh, and yes, your concerns are completely legitimate.

For someone with late/end stage dementia the appetite naturally declines. Trying to force feed pts is a pet peeve of mine.

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Specializes in LTC,Hospice/palliative care,acute care.

Several times I have intervened after speaking with family members who disagreed with their plan.The therapy dept.is really butting heads with the dietary dept.right now.No-one involved is coming from the nursing perspective.It seems the resident's right to dignity and choice are coming in dead last.They also are ignorant of nursing policy and procedures.The care plans are a mess,family members are getting phone calls that set them off ....It's not pleasant.I think I may volunteer to wade into the fray next week.Everyone is looking at their area of expertise and are very passionate about it.BUT the resident's right to dignityvtrumps all that,IMHO.

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Specializes in Pediatric Critical Care.

I think a modified adult spoon would be appropriate for feeding residents who want to eat but have limitations and are better able to take in food with a spoon that is modified to be smaller to fit the size of their opened mouth.

But a plain old baby spoon is probably cheaper than buying the one made just for adults with dementia, and works just as well.

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Specializes in Pediatric Critical Care.

Yes! I encourage you to jump in and voice the nursing perspective in an effort to improve the patient care! Especially about something you seem to be passionate about. Good luck!

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Specializes in Urology, HH, med/Surg.

By all means, advocate for the pt!! That all just sounds ridiculous!

If the family is on board for providing food/fluids ONLY when pt wants it then that should go a long way to stopping that other stuff!

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