A Study of the Relationship Between Aspiration And Refusal of Oral Intake in the Dementia Population
Date of Award
2003
Document Type
Dissertation
Degree Name
Doctor of Speech-Language Pathology
Department
Fischler Graduate School of Education and Human Services
Advisor
Charles Lonegan
Committee Member
Barbara Packer
Keywords
aspiration, dementia, diet modifications, dysphagia, feeding time, food refusal, oral intake, oral intake improvement, physical decline, skilled nursing facilities, speech-language pathologists, swallowing disorders, swallowing safety, videofluoroscopy, weight loss
Abstract
This applied dissertation was designed to identify aspiration as a possible cause of oral intake refusal in the dementia population. This was a common occurrence in the skilled nursing facility population in which the principal investigator of this project is employed. Patients with a diagnosis of dementia who had demonstrated characteristics of swallowing problems, dysphagia, weight loss, oral intake refusal of meals or liquids, decreased intake, expelling of food or liquid during meals or snacks, holding food or liquid in the mouth, change in appetite, skin integrity problems, or increased feeding time were considered for participation in this study. The goals included the following: (a) The speech-language pathologist of this skilled nursing facility was to be consulted when a patient with oral intake refusal or swallowing problems was identified; (b) 20 patients who demonstrated dementia and characteristics of oral intake refusal were to be studied; (c) videofluoroscopy was to be performed on these 20 patients in order to determine aspiration occurrence of the oral consistencies provided, and information presented in graph or table form was to be provided based on these findings; (d) at least 10 out of 20 of these patients were to have been found to demonstrate aspiration for at least one form of liquid consistency presented and were to have demonstrated the inability to manipulate and swallow safely at least one form of solid presentation; (e) the principal investigator of this project was to identify the most appropriate and safest consistencies for each patient reviewed as determined by the results of videofluoroscopy; (f) the principal investigator of this project was to provide information in graphic form indicating these patients’ oral intake 1 month prior to videofluoroscopy and 1 month following videofluoroscopy and diet modifications to denote their improved oral intake; and (g) results were expected to indicate oral intake improvement in 50% of the patients studied.
An analysis of the data revealed that 13 out of 20 patients demonstrated aspiration for at least one liquid consistency and that 16 out of 20 patients demonstrated the inability to manipulate and swallow safely any form of solid presentation during videofluoroscopy. Following videofluoroscopy and proper diet modifications, oral intake improvement was identified in 14 out of 20 patients studied.