Development of a Risk Feeding Guideline for the Management of Feeding Decisions in Hospitalised Adults with Severe Oropharyngeal Dysphagia


Book Description

Background: For patients who have severe and chronic dysphagia, decisions need to be made about the provision of nutrition and hydration. 'Risk feeding', where a patient continues to eat and drink despite risk, may be necessary in situations where enteral tube feeding is not thought to be in a patient's best interests or is not medically possible. There is emerging interest in risk feeding pathways internationally. This retrospective audit explored current complex feeding decision practices in one medium sized New Zealand hospital. Methods: Fifty patients identified at daily ward rounds across a 15-month period as involving a feeding decision were recruited. Feeding decision was defined as: an oral or non-oral feeding decision made for the continuing provision of nutrition for severe oropharyngeal dysphagia not expected to resolve during hospital admission. For each identified patient, all discharge summaries, both historical as well as future admissions (up to and including six months post recruitment) were audited. A total of 149 admissions were tallied. All episodes of care where dysphagia or dysphagia-related complications were reported as a primary or secondary diagnosis in the discharge summary were included. Inclusion terms used: dysphagia, swallowing difficulty, diet modification, chest infection. Results: Fifty patients (76% male) were included (mean age 75yrs, range 19-94, SD 14.9) including 103 admissions for dysphagia-related illness (mean admission per patient 2, range 1-16) across a range of specialities: medical, surgical, stroke, oncology and rehabilitation with a mean length of stay of 18 days (range 1-139, SD 22). Only 24% of admissions involved palliative care. Sixty percent of admissions included enteral tube feeding. Of 49 nasogastric tubes placed, 31 (63%) failed. Nil-by-mouth with total enteral tube feeding was the final feeding decision in only 11% of admissions, while, 54% of admissions led to a risk feeding decision. Dysphagia was documented in only 44% of discharge summaries; with a feeding decision documented in only 34%. Conclusions: Management of feeding decisions for patients with severe oro-pharyngeal dysphagia is complex. Convoluted, lengthy decision-making with failed enteral feeding trials is common. Omissions in transfer information regarding dysphagia and feeding decisions potentially affect continuity of care. The findings from this study support the development of an evidence-based clinical guideline for the management of risk feeding decisions.




Pediatric Swallowing and Feeding


Book Description

Pediatric Swallowing and Feeding: Assessment and Management, Third Edition provides information to practitioners interested in and involved with children who demonstrate swallowing and feeding disorders. Since the 2002 publication of the second edition, there has been an exponential increase in the number of medically fragile and complex children with swallowing/feeding disorders. A corresponding proliferation in the related basic and clinical research has resulted in the increased appreciation of the complicated inter-relationships between structures and systems that contribute to swallowing/feeding development, function, and disorders. Case studies throughout the book provide examples for decision making and highlight salient points. New to the Third Edition: * Maureen A. Lefton-Greif, PhD, CCC-SLP, BCS-S, is welcomed as co-editor. She brings extensive research expertise and clinical practice in pediatric dysphagia and feeding. * All chapters contain significant updated evidence-based research and clinical information. * New chapters focus on the genetic testing and conditions associated with swallowing and feeding disorders, and the pulmonary manifestations and management of aspiration. * World Health Organization (WHO) description of an International Classification of Functioning, Disability, and Health (ICF) sets the stage for an in-depth discussion of clinical feeding evaluation procedures, interpretation, and management decision making. Pediatric Swallowing and Feeding continues to be the leading text on pediatric dysphagia that provides practical information for clinicians seeing children with swallowing and feeding disorders. The overall importance of an appropriate fund of knowledge and shared experience employing team approaches is emphasized throughout this third edition as in the earlier editions of this book. From the Foreword: "The Editors have recognized the advances and changes in the understanding in the information now available for the care of pediatric swallowing and feeding challenges. They have recruited an outstanding group of contributors for this newest edition. There are numerous critically important updates and additions in the third edition. They have included World Health Organizations International Classification of Functioning, Disability and Health is the functional basis in all areas of the book. This text has its importance as there has been an increased number of children with complex medical and healthcare conditions which are risk for feeding and swallowing disorders. This edition stresses the need for team approaches and also documents the use of “virtual” teams ...Pediatric Swallowing and Feeding: Assessment and Management, Third Edition is the fundamental holistic source for all healthcare providers providing the care for swallowing and feeding in children. This book will be utilized by all caring for children with feeding and swallowing problems throughout the world. The previous editions have been and now this updated third edition continues to be the standard source for the information concerning diagnosis and care of these children." —Robert J. Ruben, MD, FAAP, FACS Distinguished University Professor Departments of Otorhinolaryngology – Head and Neck Surgery and Pediatrics Albert Einstein College of Medicine Montefiore Medical Center Bronx, New York







Interdisciplinary Nutritional Management and Care for Older Adults


Book Description

Intro -- Foreword -- Acknowledgements -- Contents -- Part I: Nutritional Care in Geriatrics -- 1: Overview of Nutrition Care in Geriatrics and Orthogeriatrics -- 1.1 Defining Malnutrition -- 1.2 Nutrition Care in Older Adults: A Complex and Necessary Challenge -- 1.3 Malnutrition: A Truly Wicked Problem -- 1.4 Building the Rationale for Integrated Nutrition Care -- 1.5 Managing the Wicked Nutrition Problems with a SIMPLE Approach (or Other Tailored Models) -- 1.5.1 Keep It SIMPLE When Appropriate -- 1.5.2 A SIMPLE Case Example -- 1.5.2.1 S-Screen for Malnutrition -- 1.5.2.2 I-Interdisciplinary Assessment -- 1.5.2.3 M-Make the Diagnosis (es) -- 1.5.2.4 P-Plan with the Older Adult -- 1.5.2.5 L-Implement Interventions -- 1.5.2.6 E-Evaluate Ongoing Care Requirements -- 1.6 Bringing It All Together: Integrated Nutrition Care Across the Four Pillars of (Ortho) Geriatric Care -- 1.7 Summary: Finishing Off with a List of New Questions -- References -- Recommended Reading -- 2: Nutritional Requirements in Geriatrics -- 2.1 Nutritional Recommendations for Older Adults, Geriatric and Orthogeriatric Patients -- 2.2 Nutritional Recommendations for Older Adults -- 2.2.1 Energy Requirement and Recommended Intake -- 2.2.2 Protein Requirement and Recommended Intake -- 2.2.3 Micronutrients and Dietary Fibers -- 2.3 Nutritional Risk Factors in Older Adults -- 2.4 Estimating Intake in Older Adults -- 2.5 Nutritional Status of Older Adults, Geriatric and Orthogeriatric Patients -- 2.6 Summary -- References -- Recommended Reading -- 3: Nutritional Assessment, Diagnosis, and Treatment in Geriatrics -- 3.1 The Nutrition Care Process -- 3.2 Nutritional Screening/Risk Detection -- 3.3 Nutritional Assessment and Diagnosis -- 3.3.1 Nutrition Impact Symptoms -- 3.3.2 Nutritional Diagnosis -- 3.3.3 Etiologic Criteria.




Neurogenic Dysphagia


Book Description

This book is a clinical manual that covers the whole spectrum of swallowing and its disorders. It starts with physiology of swallowing, pathophysiology of disordered deglutition, diagnostic methods (clinical and instrumental) and ends with an in-depth’s and up-to-date presentation of current treatment options. The clinically most relevant topics of dysphagia management on the stroke unit and the intensive care unit are dealt with in separate chapters. Also the closely intertwined issue of nutritional management is specifically addressed. Most importantly, the book covers all obligatory topics of the Flexible Endoscopic Evaluation of Swallowing (FEES)-curriculum, an educational initiative that started in Germany in 2014 and is currently being extended to other European and non-European countries. The book is richly illustrated and an online video section provides a number of typical patient cases. FEES is probably the most commonly chosen method for the objective assessment of swallowing and its disorders. It is used in stroke units, intensive care facilities, geriatric wards but also in rehabilitation clinics and within dedicated outpatient services. This book on neurogenic dysphagia therefore addresses a wide range of different medical disciplines, such as neurologists, geriatricians, intensive care physicians, rehabilitation physicians, gastroenterologists, otolaryngologists, phoniatrists and also speech-language pathologists.




The Yale Swallow Protocol


Book Description

The Yale Swallow Protocol is an evidence-based protocol that is the only screening instrument that both identifies aspiration risk and, when passed, is able to recommend specific oral diets without the need for further instrumental dysphagia testing. Based upon research by Drs. Steven B. Leder and Debra M. Suiter, an easily administered, reliable and validated swallow screening protocol was developed and can be used by speech-language pathologists, nurses, otolaryngologists, oncologists, neurologists, intensivists and physicians assistants. In addition, the protocol can be used in a variety of environments, including acute care, rehabilitation and nursing homes. The Yale Swallow Protocol meets all of the criteria necessary for a successful screening test, including being simple to administer, cross-disciplinary, cost effective, acceptable to patients and able to identify the target attribute by giving a positive finding when aspiration risk is present and a negative finding when aspiration risk is absent. Additionally, early and accurate identification of aspiration risk can significantly reduce health-care costs associated with recognized prandial aspiration.







Frazier Water Protocol


Book Description




Seminars in Dysphagia


Book Description

Seminars in Dysphagia provides a comprehensive overview of contemporary issues in the field of dysphagia assessment, treatment and management in diverse subject populations. Expert views are shared by international clinical experts from different medical and allied health fields. This book contains an introductory chapter on the anatomical structures and physiology processes that underpin dysphagia and discusses the effects of polypharmacy and ageing on deglutition. Contemporary practices of functional assessment of swallowing and the endoscopic assessment for both oropharyngeal and esophageal dysphagia are reviewed. Both the nutritional support and decision making in oral route are described and the impact of dysphagia on carers and family when managing dysphagia. Several chapters are dedicated to outlining the manifestation and consequences of dysphagia in specific populations, including persons with Parkinsons disease, dystonia, chronic obstructive pulmonary disease and mixed connective tissue disease.




Primary Care E-Book


Book Description

Primary Care E-Book