An Approach to Guiding and Supporting Decision-Making for Individuals With Dementia: Feeding, Swallowing, and Nutrition Considerations
Feeding and swallowing issues are common occurrences in individuals with advanced dementia. Despite the near certainty that dysphagia will arise in the later stages of dementia, families and surrogates often remain unaware that these are natural occurrences in the disease process until the individual with dementia is in a critical state. The speech-language pathologist can best initiate family guidance for decision-making regarding oral intake early in the disease process and often at/near the onset of the dementia diagnosis. This may include using instrumental swallow evaluations at onset of diagnosis to establish baseline swallow function; monitoring of nutritional lab values such as prealbumin, which is predictive of overall state of health; using feeding scales and dementia rating scales; and eliciting patient/family perspectives. Periodic monitoring of the above stated factors from the onset of diagnosis and throughout the disease can facilitate the speech-language pathologist in guiding the family, surrogate, and medical team regarding oral intake in an individual with dementia. This may prevent the poor decision-making that often results from a crisis of severe dysphagia and/or weight loss in an individual with dementia.