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Session Descriptions Dysphagia in Older Adults

2017 Dyshagia - RegistrationThese pre-recorded lectures are on-demand and last only an hour, so you can listen to them whenever time permits!

Managing Dysphagia in Older Adults: Essential Knowledge and Skills
James L. Coyle, PhD, CCC-SLP, BCS-S

Our population is aging, and aging affects human function. SLPs need to understand the effects of aging and integrate them into decisions about dysphagia management. This session will review the demographics of aging, the effects of aging on human organ systems, and key topics in dysphagia in older adults, with examples.

After completing this session, you will be able to:

  • list three medical conditions that are not typically associated with dysphagia but have elevated dysphagia prevalence 
  • describe the concept of homeostenosis and its relevance to managing dysphagia in older people 
  • state how three physiologic systems change over the life span and how these likely affect swallowing function

Oral Hygiene in Older Adults: Assessment, Care, and Complications
John R. Ashford, PhD, CCC-SLP

Inadequate oral hygiene practices can contribute to or result in severe localized and systemic illnesses, significantly altering the health status and well-being of older adults. Care providers must recognize symptoms, conditions, and their potential consequences and elevate routine oral hygiene care to oral infection control programs. This session will identify possible oral hygiene complications—from oral pain to pneumonia—and discuss how to recognize and assess them, as well as address the importance of standardized intervention.

After completing this session, you will be able to:

  • utilize a standardized oral health screening tool as part of the bedside clinical dysphagia assessment to determine the oral health status of patients, and use the results to determine the proper course of intervention 
  • incorporate oral health findings as an important clinical factor in making decisions regarding the safety of oral feeding and its potential for contributing to possible development of pneumonia from aspiration 

Optimizing Eating and Swallowing for People With Dementia
Jeanette Benigas, PhD, CCC-SLP

SLPs often face clinical challenges finding appropriate and effective treatments for people with dementia who have difficulty eating or swallowing. This session will discuss why these difficulties occur and the best evidence to address the needs of this population.

After completing this session, you will be able to:

  • identify why common eating and swallowing problems may occur for people with dementia 
  • select treatment options and the supporting evidence to assist in determining the most appropriate plan of care for people with dementia who have difficulty eating or swallowing 

Physiologic Changes and Interactions With Disease in Older Adults
James L. Coyle, PhD, CCC-SLP, BCS-S

Aging produces predictable and specific changes to the human respiratory and digestive systems and predisposes older people to more severe effects of—and more protracted limitations secondary to—diseases and surgical procedures. This session will provide much-needed, clinically translatable information about aging-related respiratory and digestive system changes and how they affect swallowing diagnosis and treatment. The session will also review the systemic inflammatory response syndrome (sepsis) as a model of an atypical dysphagia-producing illness.

After completing this session, you will be able to:

  • describe three changes in pulmonary function that naturally occur in normal aging and apply them to dysphagia assessment observations of older patients 
  • describe three changes in digestive system function that naturally occur in normal aging and apply them to dysphagia assessment observations of older patients 
  • identify the predicted effects of sepsis in observations of patient performance after recovery, and use this information to make better predictions during dysphagia assessment of older patients

Dysphagia Assessment and Management in Palliative Care
Kate Krival, PhD, CCC-SLP, and Brenda Arend, MA, CCC-SLP

SLPs may find it challenging to provide services to patients with dysphagia within a palliative care context. This session will define the SLP's role in dysphagia and related function interventions for adults in all stages of palliative care and provide a framework for establishing goals, choosing approaches, and measuring outcomes. Guidelines for clinical decision-making regarding palliative services will be based on useful principles gleaned from multiple relevant sources.

After completing this session, you will be able to:

  • identify patients who may benefit from SLP services under a palliative approach 
  • create supported recommendations for assessment and treatment for individuals in palliative care 
  • write long- and short-term goals that reflect the objectives and approaches for patients receiving dysphagia services in a palliative care context

Balancing Risks in Diet Selection for Older Adults With Dysphagia
Nicole Rogus-Pulia, PhD, CCC-SLP

This session will review key factors to consider when selecting the appropriate diet for patients with dysphagia. Discussion will include when and how to recommend thickened liquids, comparison of common thickeners, factors to consider when modifying the consistency of solids, tips for safely incorporating real foods into modified diets, and strategies to encourage adherence to these recommendations. The session will also present options for mitigating risks of negative health-related sequelae relative to specific patient populations.

After completing this session, you will be able to:

  • list the risks and benefits of fluid selection and diet modification for patients with dysphagia 
  • explain to patients how best to mitigate risks for negative dysphagia-related health sequelae 
  • explain to patients how to incorporate real foods into a modified diet for improved quality of life

Exercise-Based Dysphagia Interventions in Older Adults
Heather Clark, PhD, CCC-SLP

Clinicians have a variety of strategies at their disposal to address swallowing concerns in older adults. SLPs need a clear rationale for the strategies they select and an understanding of how they should be employed, particularly in older adults with dysphagia. This session will review in detail one subset of intervention—exercise-based treatments—and offer frameworks for decision-making.

After completing this session, you will be able to:

  • describe the nature of swallowing impairments that suggest 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

Swallowing, Cognition, and Dignity: A Clinical Pathway for Dysphagia Management in Persons With Dementia
Michelle Tristani, MS, CCC-SLP

This session will identify challenges associated with assessing patients with the dual diagnosis of dysphagia and dementia and describe how clinicians can be empowered to use a comprehensive, systematic clinical pathway to create an intervention plan that preserves safety, nutrition, hydration, and quality of life.

After completing this session, you will be able to:

  • select and utilize assessment measures—and state the benefits of these measures—that consider stage of dementia, oral and pharyngeal phase swallowing, compensatory techniques, environmental modifications, ability to sustain nutrition and hydration needs, and quality of life  
  • select and utilize appropriate compensatory techniques and interventions based on dysphagia and dementia assessment results 

Rights, Responsibilities, and Informed Consent in Dysphagia Management
Mary L. Casper, MA, CCC-SLP

Older adults who present with swallowing difficulties have unique considerations related to age and medical complexity. Polypharmacy, co-morbidities, cognitive deficits, decision-making capacity, and the patient's values must be considered in designing an effective treatment plan. SLPs need to obtain consent from patients to deliver dysphagia treatment or modify diet consistencies, and they must follow federal and state laws that require the acknowledgement and incorporation of the patient’s rights. This session provides clinicians with tools they need to consider current best evidence while effectively treating older adults with dysphagia. Legal and ethical definitions will be provided, and real-life scenarios will be reviewed to put the concepts into context.

After completing this session, you will be able to:

  • discuss end-of-life issues related to older adults who have dysphagia 
  • define consent and capacity, and apply the concepts in case studies of older adults who have dysphagia 
  • discuss the patient’s rights surrounding dysphagia treatment and diet consistency modifications

Nutrition and Dysphagia in Older Adults
Michelle McDonagh, RD, CD

Advanced age brings multiple barriers to nutrition. It is important for older adults to maintain optimal nutrition to maintain physical and mental function and quality of life. This session identifies nutritional challenges faced by older adults and explores ways SLPs can effectively collaborate on a multidisciplinary team to provide optimal nutrition for patients with dysphagia.

After completing this session, you will be able to:

  • list three barriers to nutrition specific to older adults 
  • identify vitamins/minerals that are a concern for older adults 
  • identify three approaches to improve nutrition with modified diets in the management of dysphagia

Recognizing Delirium in Individuals Who Are Medically Ill
Kevin Patterson, MD

SLPs frequently evaluate and provide rehabilitation services to patients with sudden changes in cognitive status. This session will 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 frequently goes unrecognized or is misattributed as a mental health or primary neurologic issue, which leads to inaccurate treatment and recovery approaches. This session will help SLPs recognize delirium and improve early detection and treatment for patients in hospitals and nursing home settings.

After completing this session, you will be able to:

  • discuss the differential diagnosis of neurovegetative/cognitive symptoms in a 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

Presbyphagia: Improving Assessment Practices for Older Adults
Luis F. Riquelme, PhD, CCC-SLP, BCS-S

Individuals age 65 and older are the fastest-growing segment of the U.S. population, and a change in swallowing patterns is the second most common complaint presented to geriatricians. This session will explore the latest research on presbyphagia in several segments of the older adult population, including discussion of how to incorporate research findings into clinical and instrumental assessment practices and overall decision-making.

After completing this session, you will be able to:

  • describe three specific changes related to presbyphagia in normal aging 
  • adapt dysphagia assessment protocols for older adults 
  • apply current evidence to assessment and treatment of dysphagia in older adults

Feeding Tubes: Weighing Patient and Family Preferences With Medical Recommendations
Erin Scott, MD

As medical technology evolves, determining the necessity of feeding tubes has become less concrete, and decisions about feeding tubes are even more challenging when patient and family goals conflict with medical recommendations. This session will present communication techniques for managing difficult discussions with patients, families, and medical teams and discuss guidelines for when feeding tube placement is indicated.

After completing this session, you will be able to:

  • utilize communication techniques to better elicit patient and family preferences and to manage conflict within the medical team 
  • explain the importance of prognostic awareness
  • discuss the controversy surrounding feeding tubes and why conversations about them are challenging 

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