Friday, November 14, 2014
|What bird is with you at every meal? A swallow!|
Consider the following vignettes, common in both geriatrics and palliative care:
- A 93 year old woman with advanced dementia is admitted to the hospital for the third time in the past 6 months for an aspiration pneumonia. The admitting team orders a speech and swallow consult.
- A 68 year old man suffers a massive ischemic stroke. After 15 days in the ICU he has recovered minimal function. A tracheostomy (trach) is placed so that he can breathe on a ventilator through a hole in his neck. The neurology team requests a speech and swallow consult to justify likely need for PEG (a hole into the stomach for artificial feeding through a tube).
However, at the annual Foley retreat of the National Palliative Care Research Center , Bob Arnold suggested a different approach. He has been working with his speech and swallow colleagues to develop a palliative approach to patients with difficulty swallowing.
Here are some of the changes:
Old speech and swallow recommendations:
- Unsafe for feeding
- NPO. Needs feeding tube
- High risk for aspiration
- Assess goals and values related to feeding and nutrition
Alex Smith normally blogs at GeriPal. This post appears first on Pallimed as part of a wager on the World Series. For each game lost by the home team (SF Giants for GeriPal, KC Royals for Pallimed), the losing blog must submit a post to the winning blog.
Photo Credit: jurvetson via Compfight cc