Eating Problems in Advanced Dementia: Navigating Difficult Conversations

Area of Science:

• Geriatric Medicine
• Palliative Care
• Medical Education

Background:

• Advanced dementia (AD) frequently causes eating and swallowing difficulties, impacting nutrition and quality of life.
• Palliative care for AD necessitates skills in symptom management, caregiver communication, and establishing goals of care.
• Internal medicine (IM) residents report insufficient training in managing AD patients.

Purpose of the Study:

• To assess the impact of an interactive seminar on residents' skills in managing advanced dementia.
• To improve residents' ability to address nutritional issues and goals of care in AD patients.

Main Methods:

• A small-group interactive seminar was developed, featuring a trigger video of a family meeting about eating problems in AD.
• Case-based learning, small-group discussion, and learner reflection were utilized.
• The seminar was piloted with 82 internal medicine, medicine-pediatrics, and neurology residents.

Main Results:

• Residents reported high satisfaction and found the educational content clinically relevant.
• Statistically significant improvements in self-reported confidence in dementia-specific skills were observed (p < .001).
• Large to very large effect sizes (Cohen's d = 1.3-1.7) indicated substantial impact.

Conclusions:

• The seminar effectively enhanced residents' self-efficacy in managing nutritional issues and goals-of-care discussions for AD patients.
• The training imparted crucial geriatric and palliative concepts, preparing residents for future care of older adults with AD.