Cognitive-Based Swallow Impairments, Part 3
Deficits in memory,
orientation, attention, reasoning and safety awareness directly impact a
patient's ability to participate in meals safely and efficiently for adequate
PO intake. I have a few strategies that I use regularly:
the unexpected. A patient may be calm and cooperative at breakfast, but become
agitated in the evening. One strategy may not work consistently.
additional time to arrive at the dining area and finish the meal.
prepared to provide extensive caregiver education, and develop a functional
maintenance plan to support carryover.
with nursing and dietary staff to allow the patient a variety of texture and
for assistance from nurses and staff in the dining area to limit noise and
maintain routines and structure. Seat patients in the same area.
inform nursing of any difficulties or behaviors, as well as the amount the
written/ visual strategies to increase delayed, short-term and long-term recall
to help patients recall the task at hand and participate in routines, including
memory notebooks, pictures and written instructions.
repetitive questioning, and use cognitive based strategies to redirect and
reassure, rather than focusing on correcting errors. For example, if a patient
asks everyday if he has to pay his bill, remove any menu tickets from the tray.
They may ask many times where they are and why.
patients of compensatory swallow strategies.
directions and answers short and direct.
patients forget that have eaten immediately after a meal, and may need snack
items available or smaller, more frequent meals. Never tell them, "You just
with memory problems will often forget about snacks that are brought to them,
forget to ask for and drink water, or forget where they can go to get food if
they are hungry. Remind staff to ask these patients if they want food or drink