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Speech-Language Pathologists' Views About Aspiration Risk and Comfort Feeding in Advanced Dementia.

Cathy Berkman¹, Judith C Ahronheim², Caroline A Vitale³

¹1 Graduate School of Social Service, Fordham University, New York, NY, USA.

The American Journal of Hospice & Palliative Care

|May 16, 2019

Summary

Speech-language pathologists (SLPs) sometimes recommend oral feeding for dementia patients at high aspiration risk, prioritizing quality of life and patient preferences. This involves balancing safety with palliative care near end of life.

Keywords:

advanced dementia artificial nutrition and hydration dysphagia end of life enteral nutrition ethics feeding tube speech language pathologist

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Area of Science:

Gerontology
Neurology
Speech and Hearing Science

Background:

Older adults with advanced dementia often face high aspiration risks during swallowing.
Speech-language pathologists (SLPs) assess swallowing and recommend nutritional intake for these high-risk patients.

Purpose of the Study:

To identify the specific circumstances under which SLPs recommend oral nutritional intake for patients with advanced dementia and high aspiration risk.

Main Methods:

A national probability sample of 731 SLPs participated in a mail survey.
Participants described conditions for recommending oral feeding in high-risk dementia patients.

Main Results:

Six themes emerged: patient preferences, end-of-life quality of life, aspiration risk mitigation, physician preference, documented risk, and awareness of evidence regarding feeding tubes and "nothing by mouth" status.
SLPs consider patient wishes and quality of life, especially near the end of life, when making feeding recommendations.

Conclusions:

SLPs play a crucial role in interprofessional teams, advising on swallowing risks and benefits of oral feeding for advanced dementia patients.
Recommending oral feeding for comfort involves balancing aspiration risks and can cause moral distress for SLPs.
Maximizing quality of life through palliative oral feeding is a key consideration for SLPs working with end-of-life dementia care.