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Temporal Associations between Caregiving Approach, Behavioral Symptoms and Observable Indicators of Aspiration in Nursing Home Residents with Dementia

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The journal of nutrition, health & aging

Abstract

Objectives

Dysphagia, or impaired swallowing, is common in nursing home (NH) residents with dementia and contributes to malnutrition and diminished quality of life. Dysphagia also commonly leads to aspiration or passage of food or fluids into the airway, which can result in aspiration pneumonia—a leading cause of death for people with dementia. Currently available interventions for dysphagia aim to modify the risk of aspiration events primarily by modifying diet and positioning to improve the safety of an individual’s swallow. However other potentially modifiable contextual factors relevant to mealtime care within NH settings that may influence the occurrence of aspiration events, such as the nature of caregiving interactions or occurrence of dementia-related behavioral symptoms, have not been examined. To address this gap, we examined the temporal associations between caregiving approach and behavioral symptoms as antecedents to observable indicators of aspiration among nursing home (NH) residents with dementia.

Design

Secondary analysis of coded, timedevent behavioral data from 33 video-recorded observations of mealtime interactions between NH residents with dementia and caregivers.

Setting/Participants

Residents with dementia who required assistance with mealtime care (n=12) and nursing assistants (n=8) from Memory Care Units (MCU) in 2 Midwestern NHs.

Results

Observable indicators of aspiration were significantly more likely to occur during or following task-centered caregiver actions than person-centered actions (12% likelihood; Yule’s Q 0.89; OR 95% CI 12.70-23.75) and 15-30 seconds after a behavioral symptom (5% likelihood; Yule’s Q 0.65; OR 95% CI 4.18-8.57).

Conclusions

These findings provide compelling preliminary evidence that caregiver approach may influence the occurrence of aspiration. Provided the urgent need for more approaches to mitigate the complications associated with dysphagia in people with dementia, even a moderate reduction in aspiration events may be clinically meaningful. Further, well-designed observational studies with individuals with well-characterized dysphagia are needed to better understand and characterize these relationships, their temporal structures and their impacts on other relevant outcomes such as eating performance and malnutrition.

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References

  1. Chang CC, Roberts BL. Feeding difficulty in older adults with dementia. J Clin Nurs 2008;17:2266–2274. doi: 10.1111/j.1365-2702.2007.02275.x

    Article  PubMed  Google Scholar 

  2. Simmons SF, Cleeton P, Porchak T. Resident Complaints About the Nursing Home Food Service: Relationship to Cognitive Status. J Gerontol B Psychol Sci Soc Sci 2009;64B:324–327. doi: 10.1093/geronb/gbp007

    Article  PubMed Central  Google Scholar 

  3. Keller H, Carrier N, Duizer L, et al. Making the most of mealtimes (M3): Grounding mealtime interventions with a conceptual model. J Am Med Dir Assoc 2014;15:158–161. doi: 10.1016/j.jamda.2013.12.001

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bernstein AB, Remsburg RE. Estimated Prevalence of People With Cognitive Impairment: Results From Nationally Representative Community and Institutional Surveys. Gerontologist 2007;47:250–254. doi: 10.1093/geront/47.3.350

    Article  Google Scholar 

  5. Priefer BA, Robbins J. Eating changes in mild-stage Alzheimer’s disease: a pilot study. Dysphagia 1997;12:212–221. doi: 10.1007/PL00009539

    Article  CAS  PubMed  Google Scholar 

  6. Rogus-Pulia N, Malandraki GA, Johnson S, Robbins J. Understanding Dysphagia in Dementia: The Present and the Future. Curr Phys Med Rehabil Rep 2015;3:86–97. doi:10.1007/s40141-015-0078-1

    Article  Google Scholar 

  7. Horner J, Alberts MJ, Dawson DV, Cook GM. Swallowing in Alzheimer’s disease. Alzheimer Dis Assoc Disord 1994;8(3):177–189.

    Article  CAS  PubMed  Google Scholar 

  8. Volicer L, Seltzer B, Rheaume Y, et al. Eating difficulties in patients with probable dementia of the Alzheimer type. J Geriatr Psychiatry Neurol 1989;2(4):188–195.

    CAS  PubMed  Google Scholar 

  9. Edahiro A, Hirano H, Yamada R, Chiba Y, Watanabe Y, Tonogi M, et al. Factors affecting independence in eating among elderly with Alzheimer’s disease. Geriatr Gerontol Int 2012; 12(3):481–90. doi: 10.1111/j.1447-0594.2011.00799.x

    Article  PubMed  Google Scholar 

  10. Alagiakrishnan K, Bhanji RA, Kurian M. Evaluation and management of oropharyngeal dysphagia in different types of dementia: A systematic review. Arch Gerontol Geriatr 2013;56:1–9. doi: 10.1016/j.archger.2012.04.011

    Article  PubMed  Google Scholar 

  11. Park YH, Han HR, Oh BM, et al. Prevalence and associated factors of dysphagia in nursing home residents. Geriatr Nurs 2013;34:212–217. doi: 10.1016/j.gerinurse.2013.02.01

    Article  PubMed  Google Scholar 

  12. Sarabia-Cobo CM, Pérez V, de Lorena P, et al. The incidence and prognostic implications of dysphagia in elderly patients institutionalized: A multicenter study in Spain. Appl Nurs Res 2016;30:e6–9. doi: 10.1016/j.apnr.2015.07.001

    Article  PubMed  Google Scholar 

  13. Cabré M, Serra-Prat M, Force L, et al. Oropharyngeal Dysphagia is a Risk Factor for Readmission for Pneumonia in the Very Elderly Persons: Observational Prospective Study. J Gerontol A Biol Scie Med Sci 2013;69:330–7. doi: 10.1093/gerona/glt099

    Google Scholar 

  14. Takeuchi K, Aida J, Ito K, et al. Nutritional status and dysphagia risk among community-dwelling frail older adults. J Nutr Health Aging 2014;18:352–357. doi: 10.1007/s12603-014-0025-3

    Article  CAS  PubMed  Google Scholar 

  15. Paranji S, Paranji N, Wright S, Chandra SA. Nationwide Study of the Impact of Dysphagia on Hospital Outcomes Among Patients With Dementia. Am J Alzheimers Dis Other Demen 2017;32(1):5–11. doi:10.1177/1533317516673464.

    Article  PubMed  Google Scholar 

  16. Brunnström HR, Englund EM. Cause of death in patients with dementia disorders. Eur J Neurol 2009;16(4):488–492. doi:10.1111/j.1468-1331.2008.02503.x.

    Article  PubMed  Google Scholar 

  17. Colodny N. Dysphagic independent feeders’ justifications for noncompliance with recommendations by a speech-language pathologist. Am J Speech Lang Pathol 2005;14(1):61–70. doi:10.1044/1058-0360(2005/008)

    Article  PubMed  Google Scholar 

  18. Robbins J, Gensler G, Hind J, et al. Comparison of 2 interventions for liquid aspiration on pneumonia incidence: a randomized trial. Ann Intern Med 2008;148(7):509–518. doi: 10.7326/0003-4819-148-7-200804010-00007

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gilmore-Bykovskyi AL, Roberts TJ, Bowers BJ, et al. Caregiver Person-Centeredness and Behavioral Symptoms in Nursing Home Residents with Dementia: A Timed-Event Sequential Analysis. Gerontologist 2015;55:S61–S66. doi: 10.1093/geront/gnu164

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gilmore-Bykovskyi AL. Caregiver Person-Centeredness and Behavioral Symptoms during Mealtime Interactions: Development and Feasibility of a Coding Scheme. Geriatr Nurs 2015;36:S10–S15. doi: 10.1016/j.gerinurse.2015.02.018

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wright L, Cotter D, Hickson M. The effectiveness of targeted feeding assistance to improve the nutritional intake of elderly dysphasic patients in hospital. J Hum Nutr Diet 2008;21(6):555–562. doi: 10.1111/j.1365-277X.2008.00915.x.

    Article  CAS  PubMed  Google Scholar 

  22. Niezgoda H, Keller H, Steele C, Chambers L. What should a case-finding tool for dysphagia in long-term care residents with dementia look like? J Am Med Dir Assoc 2014;15(4):296–298. doi: 10.1016/j.jamda.2014.01.001

    Article  PubMed  PubMed Central  Google Scholar 

  23. Troche MS, Okun MS, Rosenbek JC, Altmann LJ, Sapienza CM. Attentional resource allocation and swallowing safety in Parkinson’s disease: a dual task study. Parkinsonism Relat Disord 2014;20(4):439–443. doi:10.1016/j.parkreldis.2013.12.011. doi: 10.1016/j.jamda.2014.01.001

    Article  PubMed  PubMed Central  Google Scholar 

  24. Edvardsson D, Winblad B, Sandman PO. Person-centered care of people with severe Alzheimer’s disease: current status and ways forward. Lancet Neurol 2008;4:362–367. doi: 10.1016/S1474-4422(08)70063-2

    Article  Google Scholar 

  25. Simmons SF, Rahman AN. Next steps for achieving person-centered care in nursing homes. J Am Med Dir Assoc 2014;15:615. http://dx.doi.org/10.1016/j. jamda.2014.06.008

    Article  PubMed  Google Scholar 

  26. Miller SC, Looze J, Shield R, et al. Culture change practice in US nursing homes: Prevalence and variation by state Medicaid reimbursement policies. Gerontologist 2014;54:434–445. https://doi.org/10.1093/geront/gnt020

    Article  PubMed  Google Scholar 

  27. Koren MJ. Person-centered care for nursing home residents: The culture-change movement. Health Aff 2010;29:312–317. https://doi.org/10.1377/hlthaff.2009.0966

    Article  Google Scholar 

  28. Simmons SF, Osterweil D, Schnelle JF. Improving food intake in nursing home residents with feeding assistance: a staffing analysis. J Gerontol A Biol Sci Med Sci 2001;56(12):790–794. doi: https://doi.org/10.1093/gerona/56.12.M790.

    Article  Google Scholar 

  29. Mamhidir AG, Karlsson I, Norberg A, Mona K. Weight increase in patients with dementia, and alteration in meal routines and meal environment after integrity promoting care. J Clin Nurs 2007;16(5):987–996. doi: 10.1111/j.1365-2702.2006.01780.x

    Article  PubMed  Google Scholar 

  30. Watson R, Green SM. Feeding and dementia: a systematic literature review. J Adv Nurs 2006;54(1):86–93. doi: 10.1111/j.1365-2648.2006.03793.x

    Article  PubMed  Google Scholar 

  31. Lyketsos CG, Carrillo MC, Ryan JM, et al. Neuropsychiatric symptoms in Alzheimer’s disease. Alzheimer’s Dement 2011;7(5):532–9. doi: 10.1016/j.jalz.2011.05.2410.

    Article  Google Scholar 

  32. Kales HC, Gitlin LN, Lyketosos CG. Assessment and management of behavioral and psychological symptoms of dementia. BMJ 2015;350:h369. doi: https://doi. org/10.1136/bmj.h369

  33. Coleman CK, Medvene LJ, Van Haitsma K. A person-centered care intervention for geriatric certified nursing assistants. Gerontologist 2013;53:687–698. doi: 10.1093/geront/gns135

    Article  PubMed  Google Scholar 

  34. Lann-Walcott H, Medvene LJ, Williams K. Measuring the person-centeredness of caregivers working with nursing home residents with dementia. Behav Ther 2011;42:89–99. doi: 10.1016/j.beth.2010.02.005

    Article  Google Scholar 

  35. Rosen J, Burgio L, Kollar M, et al. The Pittsburgh Agitation Scale: A user-friendly instrument for rating agitation in dementia patients. Am J Geriatr Psychiatry 1994;2:52–59. doi: 10.1097/00019442-199400210-00008

    Article  CAS  Google Scholar 

  36. Carnaby-Mann G, Lenius K. Bedside examination of dysphagia. Phys Med Rehabil Clin N Am 2008;19:747–68. doi: 10.1016/j.pmr.2008.05.008

    Article  PubMed  Google Scholar 

  37. McComas JJ, Moore T, Dahl N, et al. Calculating contingencies in natural environments: Issues in the application of sequential analysis. J Appl Behav Anal 2009;42:413–423. doi: 10.1901/jaba.2009.42-413

    Article  PubMed  PubMed Central  Google Scholar 

  38. Reimer HD, Keller HH. Mealtimes in Nursing Homes: Striving for Person-Centered Care. J Nutr Elder 2009;28:327–347. doi: 10.1080/01639360903417066

    Article  PubMed  Google Scholar 

  39. Algase D, Beck C, Kolanowski A, et al. Need-driven dementia-compromised behavior: An alternative view of disruptive behavior. Am J Alzheimers Dis Other Demen 1996;11(6):10–9.

    Article  Google Scholar 

  40. Leder SB, Suiter DM, Lisitano Warner H. Answering orientation questions and following single-step verbal commands: effect on aspiration status. Dysphagia 2009;24(3):290–295. doi:10.1007/s00455-008-9204-x.

    Article  PubMed  Google Scholar 

  41. O’Horo J, Rogus-Pulia N, Garcia-Arguello L, Robbins J, Safdar N. Bedside Diagnosis of Dysphagia: A Systematic Review. J Hosp Med 2015; 10(4):256–65. doi: 10.1002/jhm.2313.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Aselage MB. Measuring mealtime difficulties: eating, feeding and meal behaviours in older adults with dementia. J Clin Nursing 2010;19:621–631. doi: 10.1111/j.1365-2702.2009.03129.x

    Article  Google Scholar 

  43. Liu W, Cheon J, Thomas SA. Interventions on mealtime difficulties in older adults with dementia: a systematic review. Int J Nurs Stud 2014;51:14–27. doi: 10.1016/j.ijnurstu.2012.12.021

    Article  PubMed  Google Scholar 

  44. Whear R, Abbott R, Thompson-Coon J, Bethel A, Roger M, Hemsley A, Stahl-Timmins W, Stein K. Effectiveness of mealtime interventions on behavior symptoms of people with dementia living in care homes: a systematic review. J Am Med Dir Assoc 2014;15:185–93. doi: 10.1016/j.jamda.2013.10.016

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. University of Wisconsin-Madison School of Nursing, 3173 Cooper Hall, 701 Highland Avenue, Madison, WI, 53705, USA

    Andrea L. Gilmore-Bykovskyi

  2. University of Wisconsin-Madison School of Medicine & Public Health, Department of Medicine, Division of Geriatrics, 750 Highland Ave, Madison, WI, 53726, USA

    Andrea L. Gilmore-Bykovskyi & N. Rogus-Pulia

  3. William S. Middleton Memorial Veterans Hospital Geriatric Research Education and Clinical Center (GRECC), 2500 Overlook Terrace, Madison, WI, 53705, USA

    Andrea L. Gilmore-Bykovskyi & N. Rogus-Pulia

  4. University of Wisconsin-Madison School of Medicine & Public Health, Department of Surgery, Division of Otolaryngology-Head and Neck, 750 Highland Ave, Madison, WI, 53726, USA

    N. Rogus-Pulia

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  1. Andrea L. Gilmore-Bykovskyi
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Correspondence to Andrea L. Gilmore-Bykovskyi.

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Gilmore-Bykovskyi, A.L., Rogus-Pulia, N. Temporal Associations between Caregiving Approach, Behavioral Symptoms and Observable Indicators of Aspiration in Nursing Home Residents with Dementia. J Nutr Health Aging 22, 400–406 (2018). https://doi.org/10.1007/s12603-017-0943-y

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  • DOI: https://doi.org/10.1007/s12603-017-0943-y

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