Lessons from Nursing Home Dysphagia Malpractice Litigation

Tanner, Dennis C.

doi:10.3928/00989134-20100202-06

Cited by 17 publications

(9 citation statements)

References 8 publications

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“…Although the risks are acknowledged for those in long-term care, the dangers of food suffocation among older people are not as well known in the general population 20. Eating semi-solid foods such as peanut butter, having poor dentition and consuming alcohol and medication such as sedatives and antipsychotic drugs are all risk factors for food suffocation among older adults 2 4 21 22.…”

Section: Discussionmentioning

confidence: 99%

Food-related choking deaths among the elderly

2013

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During 2007-2010 in the USA, 2214 deaths among people aged ≥65 were attributed to choking on food. The death rate for this cause is higher among the elderly than among any other age group. Using data from the US National Vital Statistics System, we examined the relationship between food suffocation and other causes of death listed on the death certificate. Among decedents aged ≥65, the three most common additional conditions listed on the death certificate were heart disease, dementia and diabetes. However, after estimating the expected joint frequency of other causes based on the overall distribution of all causes of death, we find that three causes-dementia (including Alzheimer's disease), Parkinson's disease and pneumonitis-are most strongly associated with deaths from choking on food among older people.

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Section: Discussionmentioning

confidence: 99%

Food-related choking deaths among the elderly

2013

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“…Another challenge is the notion of perceived legal risks, 26 as noted by the SLPs who would recommend continued oral intake only if the risk of aspiration was clearly documented, and clearly understood by family members. Several SLPs stated they require signed waivers from family members of patients residing in facilities before recommending or “allowing” comfort feeding.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Rehabilitative and compensatory strategies such as postural changes, efforts to improve swallowing skill and coordination, as well as feeding strategies need to be studied further to ascertain relevant health and quality-of-life outcomes. 31 Scholarly inquiry is also needed to distinguish perceived legal risks 26 from actual ones, and to identify other system barriers that influence SLP recommendations for comfort-oriented approaches.…”

Section: Future Researchmentioning

confidence: 99%

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

Berkman

Ahronheim

Vitale

2019

Am J Hosp Palliat Care

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Background: Speech-language pathologists (SLPs) are often called upon to assess swallowing function for older adults with advanced dementia at high risk of aspiration and make recommendations about whether the patient can safely continue oral nutrition. Objective: To describe the circumstances under which SLPs recommend oral nutritional intake for these patients. Methods: A mail survey of a national probability sample of SLPs (n = 731). Speech-language pathologists were asked if there were circumstances in which they would recommend oral feeding for patients with advanced dementia at high risk of aspiration, and if yes, to describe the circumstances under which they do so. Results: Six themes emerged: (1) when patient preferences are known; (2) for quality of life near end of life; (3) if aspiration risk mitigation strategies are employed; (4) if physician’s preference; (5) if aspiration risk is clearly documented and acknowledged; and (6) if SLP is knowledgeable about current evidence of lack of benefit of feeding tubes in advanced dementia or that nothing by mouth status will not necessarily prevent aspiration pneumonia. Conclusions: Speech-language pathologists have an important role within the interprofessional team in assessing swallowing in patients with advanced dementia, advising family and hospital staff about risks and benefits of oral feeding, and the safest techniques for doing so, to maximize quality of life for these patients near the end of life. Speech-language pathologists are often faced with balancing concerns about aspiration risk and recommending the more palliative approach of oral feeding for pleasure and comfort, potentially creating moral distress for the SLP.

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“…Second, all subjects were young, healthy volunteers (staff of our hospital). By contrast, in clinical practice, it is older patients who tend to suffer from dysphagia [19,20]. To obtain data more immediately relevant to clinical situations, further studies need to include older individuals.…”

Section: Discussionmentioning

confidence: 99%

Effects of Posture on Subjective Swallowing Difficulty during Screening Tests for Dysphagia

Okitsu¹

2013

nt J Phys Med Rehabil

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Lessons from Nursing Home Dysphagia Malpractice Litigation

Cited by 17 publications

References 8 publications

Food-related choking deaths among the elderly

Food-related choking deaths among the elderly

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

Effects of Posture on Subjective Swallowing Difficulty during Screening Tests for Dysphagia

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