American Speech-Language-Hearing Association

Dysphagia in Older Adults

Curriculum

We handpicked these sessions to enable you to adjust your practice patterns to address the special needs of the older patient.

We've divided the sessions into three tracks:

These pre-recorded lectures are on-demand and last only an hour, so you can listen to them whenever time permits!

Track 1: Ethical Issues in Patient Management

Balancing Risks in Diet Selection

Jacqueline Hind, MS, CCC-SLP, BRS-S
Nicole Pulia, PhD, CCC-SLP

In this session, you'll learn the key factors to consider when selecting the appropriate diet for your patients with dysphagia. We'll focus on the type and timing of thickened liquids while comparing common thickeners based on the evidence. We'll present options for mitigating risks of negative health-related sequelae, and we'll review factors related to complying with diet modification and carry-over recommendations to home or supported-living environments. Finally, we'll provide tips to incorporating real foods safely into modified diets.

Learning Outcomes
You will be able to:

  • weigh the risks and benefits of fluid selection for your patients with dysphagia relative to understanding the differences between available products
  • educate patients on how best to mitigate risks for negative dysphagia-related health sequelae
  • educate patients on how to incorporate real foods into a modified diet for improved quality of life

Evidence-Based Decisions for Tube Feeding in Clients With Advanced Dementia

Thomas Finucane, MD

For people with advanced dementia who are permanently recumbent, aspiration is a serious risk. Aspiration and malnutrition are common in these patients. Percutaneous endoscopic gastrostomies are commonly used to reduce the risk of aspiration pneumonia and to provide "adequate nutrition and hydration."

There are essentially no good randomized controlled trials of whether this intervention is effective for these indications. There is a priori little reason to believe that feeding via PEG-tube reduces the risks of aspiration pneumonia. The major adverse outcomes attributable to malnutrition are not improved in patients receiving tube feeding.

Patterns of utilization vary tremendously from state to state. Several patient-related factors and several factors related to characteristics of the long-term care facilities have a strong effect on utilization patterns.

Learning Outcomes
You will be able to:

  • outline for patients the main types of neurogenic dysphagia
  • review problems with the concept of "aspiration pneumonia"
  • define questions about the value of swallowing studies
  • review data about modifying the consistency of food and drink
  • suggest alternative strategies for people who aspirate
  • describe the limited value of tube feeding in reducing the risk of aspiration pneumonia

Rights, Responsibilities, and Informed Consent in Dysphagia Practice

Mary L. Casper, MA, CCC-SLP

SLPs delivering dysphagia services to older adults are challenged to make the best professional recommendations for diet consistency and treatment interventions while respecting the client's rights. To do so, SLPs must have information about the array of choices and the risks and benefits associated with each choice. However, an SLP may perceive that his or her professional recommendations may open up the potential for liability or litigation. To achieve successful outcomes in dysphagia care with older adults, SLPs must have a clear understanding of and ability to apply the principles of informed consent.

Learning Outcomes
You will be able to:

  • explain four components of informed consent
  • discuss person-centered care and the impact on the SLP's service delivery for this population
  • examine patient rights in various health care settings
  • describe best practices in documentation for SLPs providing services to this population

Palliative Care: Enhance Participation Outcomes in Swallowing and Related Activities

Kate Krival, PhD, CCC-SLP

This session begins with an overview of palliation in health care, then defines the SLP's role when working with adults who have dysphagia and are in any stage of palliation (not just imminent end-of-life). Next, we'll provide a framework for establishing goals, choosing approaches, and measuring outcomes for clients with dysphagia in palliative care. Finally, we'll present guidelines for clinical decision-making regarding palliative services that are based in medical-ethical principles and a World Health Organization framework.

Learning Outcomes
You will be able to:

  • describe the history and current definitions of palliative care in the U.S.
  • describe the SLP's role in the care of patients with dysphagia and a palliative plan of care
  • establish goals and organize interventions for successful participatory swallowing outcomes in palliative care

Track 2: Swallowing Assessment and Treatment

Treating Dysphagia in the Older Adult: Essential Knowledge and Skills

James L. Coyle, PhD, CCC-SLP, BRS-S

The length of time we spend in school has not kept pace with the number of disorders SLPs treat, leaving an information gap. In this session, we'll supplement your knowledge base, enabling you to consider many of the effects of aging on human function and to understand the importance of adapting procedures and decision-making rules to accommodate the special needs of the older patient.

Learning Outcomes
You will be able to:

  • define homeostenosis and discuss its effects on physiologic reserve in aging
  • name three categories outside traditional SLP graduate education that are necessary to properly manage older patients with dysphagia
  • list three aerodigestive tract differences between younger and older adults

Comparing Dysphagia With Presbyphagia: Assessing the Older Adult

Luis F. Riquelme, PhD, CCC-SLP, BRS-S

In this session, we'll compare common trends in the clinical dysphagia examination with what we now know about presbyphagia, or the aging swallow. We'll describe the common etiologies for dysphagia and their impact on physiology, while discussing uncommon etiologies (e.g., UTI) and the role they play in temporary oropharyngeal dysphagia. We'll also share the best timing of and common findings during instrumental assessments (e.g., videofluoroscopy). Throughout the session, we'll focus on decision-making and the evidence to support it.

Learning Outcomes
You will be able to:

  • describe age-related changes in swallow physiology
  • outline current trends in conducting a clinical dysphagia evaluation
  • determine the best timing for conducting instrumental assessments
  • provide examples of common pitfalls during instrumental exams with this population
  • outline three evidence-based procedures for better assessment of the older adult

Nutrition Care and Dysphagia in Geriatric Patients

Jennifer Mahnke, MS, RD, LD, CSO

Hone your ability to function on a multidisciplinary dysphagia team while gaining a better understanding of the unique nutrition needs and deficiencies adults face as they age. We'll also discuss interventions designed to improve the nutrition status of geriatric patients. Afterwards, you'll be more equipped to consider the comprehensive picture of a patient's care when making therapy and modified diet recommendations.

Learning Outcomes
You will be able to:

  • describe the nutritional needs and issues in geriatric patients
  • list barriers to optimal nutrition status in this population
  • identify causes and nutritional consequences of dysphagia in geriatric patients
  • describe the effect of modified textured diets on nutrition status

Effects of Exercise-Based Dysphagia Interventions

Heather Clark, PhD, CCC-SLP

The exercise programs described in the literature vary from the muscle groups targeted, the nature and degree of overload induced by the programs, and even the dosage schedules. Moreover, the quality of available evidence to support specific exercise programs in older adults varies. In this session, we'll learn about the potential contribution exercise-based interventions make to a comprehensive dysphagia rehabilitation program for older patients, helping you identify the most appropriate exercise-based interventions for the individual's needs.

Learning Outcomes
You will be able to:

  • describe the nature of swallowing impairments suggesting the need for exercise-based interventions
  • identify and describe a variety of exercise-based interventions, and explain their intended effects
  • discuss the evidence available to support exercise-based dysphagia interventions in elderly populations

Oral Hygiene in Older Adults: Complications, Assessment, and Care

John R. Ashford, PhD, CCC-SLP

Pneumonia is the leading cause of mortality among those living in residential nursing care facilities. The primary causes of pneumonia are poor oral conditions and unsafe swallowing coupled with poor health. In this presentation, we'll examine oral assessment and its tools. We'll wrap up our discussion on how to implement institutional oral hygiene and staff training programs.

Learning Outcomes
You will be able to:

  • describe the oral cavity and its flora and the conditions that alter this environment that may lead to developing pneumonia from aspiration
  • use proven oral assessment tools to examine and evaluate the oral structures and environment
  • describe and use specific oral hygiene practices for older adults with dysphagia and dementia
  • use information and references to create a basic oral care program
  • identify patient and staff issues that may deter effective oral hygiene practices

Track 3: Anatomic, Physiologic, and Psychosocial Issues

Make the Most of Mealtime: Compensating for Sensory Impairment

Jennifer A. Brush, MA, CCC-SLP

Older adults and people with dementia experience a variety of sensory changes that affect their ability to function independently during meals. Swallowing dysfunction that results from aging or dementia can be exacerbated by environmental barriers such as inadequate lighting, noisy conditions, poor or absent environmental cues, and visual clutter. In this session, we'll learn how to address these environmental barriers as part of a comprehensive treatment plan for older adults with dysphagia. Finally, we'll share research on the physical and social environment.

Learning Outcomes
You will be able to:

  • identify the normal changes in vision, hearing, taste, smell, and touch that are part of the aging process
  • discuss the sensory changes that are part of dementia
  • incorporate the physical environment into the dysphagia assessment
  • identify aspects of the environment that can be modified to support functioning during meals

Aging and the Respiratory Functions of the Aerodigestive Tract: What's Normal and What's Not

James L. Coyle, PhD, CCC-SLP, BRS-S

As SLPs, we cannot assess swallowing and speech function without a keen understanding of the physiologic functions of the respiratory system. These respiratory and ventilatory functions predict the quality of many things the patient does including talking and swallowing. In this session, we'll provide a deeper understanding of the disease processes that affect communication and swallowing so you can more effectively manage communication and swallowing disorders in sick older adults.

Learning Outcomes
You will be able to:

  • name three structural changes in the respiratory system associated with aging
  • name three physiologic changes in the respiratory system associated with aging
  • identify abnormally rapid respiratory rate, low oxygen saturation, and common arterial blood gas values

Recognizing Delirium in Those Who Are Medically Ill

Kevin R. Patterson, MD

SLPs frequently evaluate and provide rehabilitation services to patients with sudden changes in cognitive status. In this session, we’ll provide a foundation for understanding delirium—one of the most common reasons for acute cognitive change among older adults. As a symptom of other underlying medical issues, delirium is frequently not recognized or is misattributed as a mental health or primary neurologic issue, which leads to inaccurate treatment and recovery approaches. This session will help you recognize delirium and improve early detection and treatment to patients in hospitals and nursing home settings.

Learning Outcomes
You will be able to:

  • discuss the differential diagnosis of neurovegetative/cognitive symptoms in the patient who is hospitalized or in a skilled nursing facility
  • describe the criteria that help differentiate delirium from dementia and other chronic cognitive change
  • compare the treatment approaches for patients who are delirious with patients who have chronic cognitive change

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