Guest Columns

Thinking beyond the swallow

Renee Kinder
Renee Kinder

Meal times are well-defined, often highly structured and supervised intervals during the day in many skilled nursing facilities.

They also provide a constant, routine opportunity for residents to come together to communicate, socialize and interact with others.

The all eyes on mentality during dining provides an opportunity for caregivers to make note of likes and dislikes, food preferences, dietary needs and dreaded problems with swallowing.

Mr. Jones is clearing his throat, IS HE OK?

Mrs. Adams seems short of breath and takes forever to eat her meals. Should we change her diet?

Mr. Smith eats so fast I am afraid he will choke! And he will not slow down. Does he have trouble swallowing?

Dysphagia, as defined by Medicare, is difficulty swallowing which can cause food to enter the airway, resulting in coughing, choking, pulmonary problems, aspiration or inadequate nutrition and hydration with resultant weight loss, failure to thrive, pneumonia and death.

Additionally, the statistics related to swallowing impairments in the geriatric population are staggering including:

  • Patients over 75 have double the risk of dysphagia associated with hospitalization.
  • Patients with dysphagia have 40% longer length of stay in the acute cares setting than patients without dysphagia.
  • And, patients with dysphagia undergoing rehabilitation have a 13-fold increase in mortality when compared to those without dysphagia.

Most healthcare providers and caregivers can identify the telltale signs of difficulty swallowing such as coughing with intake, spitting of foods, refusal of meals, and subsequent weight loss.

However, are we missing some of the other key identifiers that impact meal time success?

For instance, how does respiratory compromise affect swallow function? Research shows the presence of COPD can be the most significant risk factor for aspiration pneumonia in nursing home patients. Additionally, a period of apnea which occurs during the swallow affects breath patterns while eating making meal time experiences more challenging and laboring for individuals with reduced respiratory functioning.

Sensory impairments related to sight and taste can result in significant impairments impacting an individual's ability to see items on their plate secondary to reduced contrast and color saturation or poor lighting and reduction in number of taste buds beginning around age 40 to 50 in women and 50 to 60 in men can greatly impact taste.

Hearing loss can impede ability to hear conversational interactions in noisy dining environments with excessive levels of background noise.

Cognitive and expressive/receptive language impairments can result in decreased ability to attend to meal time tasks, reduced ability to understand caregivers and dining partners and limited ability to effectively communicate wants, needs and ideas with others limiting socialization. Severe impairments can result in reduced overall intake of foods secondary to over or under stimulation during meals.

I challenge you all to consider all factors when creating peaceful and meaningful dining experiences.  

Does Mr. Jones simply need an additional drink at meals to clear his food more effectively?

Perhaps Mrs. Adams needs to be one of the first to receive her tray so she can take her time eating while enjoying quality time with others.

And consider that Mr. Smith is simply overwhelmed and anxious with the amount of noise and needs to dine in a quiet area.

Renee Kinder, MS, CC-SLP, RAC-CT is a clinical specialist at Evergreen Rehabilitation in Louisville, KY.

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