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[Dysphagia] Practice approaches
The available information, over the past ten years, shows that even with thickened fluids, the elderly do not consume enough water. For those of you who feel that there is a place let me ask - Do you follow these patients up to either disvharge or death on a regular basis? Do you know whether or not they develop UTIs, orthostatic hypotension, repeated falls, severe constipation etc.? If they improve on all of these measures so much the better. My experience is that they do not - and that's where 'clysis becomes a life saver, often to the point of being able to send the patient home on it. At the recent AMDA conference, I met one physician from the US who regularly uses it and even he had no idea why his colleagues seem to be afraid of it since few things could be simpler or more effective.
Deanna Rolfe <drolfe at nsccahs.health.nsw.gov.au> wrote: I have had similar experiences, with some patients who prefer the
thickened fluids as they find them easier to swallow/control, and stop
them coughing, or they no longer have respiratory signs.
I have had a number of elderly patients who have been admitted to
hospital with dehydration, I get asked to see them, find they are
coughing on fluids and then they refuse to have more after they cough. I
then try a nectar consistency...no coughing...patient drinks the whole
cup. These are often patients who don't have the cognitive abilities to
implement compensatory techniques or therapy.
I work across both inpatient acute services and outpatients, so I get
to see people across the spectrum, and often find better outcomes with
thickened fluids.
So I, too, feel there is a place for them, but agree that they can be
overused.
Deanna
>>> "gerriann jackson" 14/06/2007 11:53:09
AM >>>
I promote free water between meals, after oral care for my dysphagia
patients. I cannot, however, ignore the many videos that I have
performed
that demonstrate quite clearly a person aspirating on thin and
tolerating
thickened liquids. Nor can I ignore the patients who I follow over
time
(LTC attached to hospital) who have experienced relief from chronic
upper
respiratory symptoms, including repeated pneumonias after being placed
on
thickened liquids.
Research and evidence based practice are important to my practice.
However,
there is also evidence and knowledge to be gleaned from every patient
that I
treat. Those patients and their outcomes tell me that although
probably
overused, there is an appropriate place for thickened liquids in the
LTC
setting.
Gerriann Jackson
-----Original Message-----
From: dysphagia-bounces at dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com]On Behalf Of Vera Karger
Sent: Wednesday, June 13, 2007 9:39 PM
To: Irene Campbell-Taylor
Cc: dysphagia at b9.com
Subject: Re: [Dysphagia] Practice approaches
Irene,
I'm relieved to be able to return my patients to water. They are as
well.
Not having read the study directly, perhaps you can fill me - us - in
on whether it's suggested that a squeeze of lemon, lime or perhaps
juice for flavoring may be used? Some patients really dislike plain
water.
Vera Karger, M.S., CCCS
Monroe, CT
vkargerslp at mac.com
On Jun 13, 2007, at 9:26 PM, Irene Campbell-Taylor wrote:
> I have the impression from recent posts that few, if any, are
> paying heed to Logemann's findings on the dangers of thickened
> fluids in the elderly in long term care- dehydration, aspiration of
> thickened liquids etc. Why continue with something that has long
> been known and now proven to be dangerous?
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
> _______________________________________________
> Dysphagia mail list: Normal and disordered swallowing information
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