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[Dysphagia] Swallowing and dementia
Patients as described are palliative therefore the responsibility lies with the physician to designate them as such so that they may be fed only what they want, when they want, in the amounts they want recognizing that nutrition/hydration is of lesser importance in the dying patient than is comfort and dignity.
"Buckie,Marcia" <mbuckie@dmc.org> wrote:Yes, this is a huge issue in my clinical experience, I have found it to be so at two seperate hospitals. Sorry such a delayed response. MPB
-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
Behalf Of Candace Grant
Sent: Saturday, October 30, 2004 9:00 AM
To: dysphagia listserve
Subject: [Dysphagia] Swallowing and dementia
I am wondering if this is of concern to anyone else... Slowly over the past few years I have been getting more and more referrals in the acute care hospital for "swallowing" evaluations for patients who have this general history: either multiple strokes or probable Alzheimer's for many years, decrease in function over that period of time to bedbound, decrease in feeding ability. They enter the hospital for either "aspiration pneumonia" (yes, Irene!) or dehydration or a combination of the two. The question I am asked is: "Can Mrs. X swallow?" I usually find someone who has limited to no communication, severely to profoundly cognitively impaired, often contracted, maybe with pressure sores. At bedside, I find that they have poor oral stage abilities- inability to hold a bolus, inability to initiate a swallow, although once they do, they do a pretty good job. However, because trying to hand feed them is such a labor intensive task, the physician and family opt for an NG tube and maybe a
gastrostomy. We have no palliative care physicians. If I recommend "careful hand feeding and excellent oral care", I get feedback that "We can't let them starve." I have given out all the articles I know of re: feeding tubes in advanced dementia, and seem to get nowhere. I saw two such ladies yesterday, and I work in a relatively small hospital. Our community has a belief that one must "do everything." There really isn't anything you all can do, but I am just wondering if anyone else has noticed this trend. It is as if medicine has lost all logic and common sense. Thanks.
Candace A. Grant_______________________________________________
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