Cognitive-based Swallow Impairments
There is often no easy
answer to address swallowing deficits in the elderly. I am sometimes approached
by staff and families because a resident "cannot swallow" or "is not eating/
drinking/ taking medications," but upon evaluation, I find no physical cause,
but rather a cognitive-based problem.
There are other patients
who do have obvious physical deficits related to swallowing, and also present
with a complex medical history that includes cognitive deficits. Meal times can
be quite challenging for these patients, as deficits, memory, attention,
reasoning and orientation interfere with the patient's ability to safely and
efficiently consume liquids and solids for adequate nutrition and hydration.
Some of the common cognitive-based
deficits that impact intake during meals include:
in memory and orientation. These are the patients who won't eat because they
are worried that they don't have money to pay or that you are not eating. These
residents also might state that they "just ate" and are not hungry now. If it's
dinner time, they might think it is early in the morning.
deficits that take the person's focus away from meals. Residents that are
constantly distracted by noise, movement or even their own thoughts do not
consume an adequate amount of food.
aversion can cause patients to spit out foods that are "grainy" or "bitty" even
though they are able to chew and swallow those consistencies without overt
agitation, and behavioral disturbances associated with dementia can cause some
patients to suspect meals are poisoned or that eating a meal will result in
some sort of problem, such as the patient being accused of stealing food.
behaviors that keep patients from sitting through a meal obviously prevent that
patient from consuming an adequate amount during a meal.
deficits can cause patients to refuse to start eating if they feel there is too
much food on their plates. They don't want to start eating if they might
"waste" food that someone else could eat.
The examples above are
common issues I try to address with patients, but therapy becomes complicated
as there are no exercises or maneuvers that can reduce the problems. The
solution lies in staff and family education, environmental and diet texture
modification, and cognitive-linguistic retraining. Next week I will offer some
approaches to cognitive-based swallow dysfunction that I have used. In the mean
time, please share what works for you.