SpeechPathology.comPhone: 800-242-5183

New master brand. Same great company. Introducing continued! Read Our Story

Mediscan School Based Therapy

Dysphagia and Nutrition Management In Patients With Dementia: The Role of the SLP

Dysphagia and Nutrition Management In Patients With Dementia: The Role of the SLP
Susan M. Curfman, MA, CCC-SLP
May 23, 2005

Research and statistics clearly indicate that dehydration and malnutrition are prevalent and serious concerns with our residents in skilled nursing facilities (SNF). Studies indicate that 54% of all SNF admissions are malnourished; the range of malnourished elderly in SNFs range from 20-87%. In addition, 60% of all residents experience an initial weight loss following admission. The financial impact of dehydration and malnutrition are illustrated with the following statistic in that $1.3 billion spent in 1996 by CMS for acute hospital care with primary diagnosis of dehydration.

Many of these residents quoted in these statistics have a dementia diagnosis, which places them at higher risk for weight loss and dehydration. Current statistics estimate that 60-80% of all residents in long-term care have a dementia diagnosis. Adequate nutrition and hydration in an individual with dementia is a central concern for all members of the family and healthcare team.

The impact of dementia on nutrition and hydration changes throughout the course of the degenerative disease process. In the early stage, the individual with dementia may forget to eat, may become depressed and not want to eat, or become distracted and leave the table without eating. In the middle stage, the individual with dementia may be unable to sit long enough to eat, yet at this stage may require an additional 600 calories per day due to wandering and motor restlessness. In the late stage, the individual with dementia does not have intact oral motor skills for chewing and swallowing, thus becomes subject to malnourishment and "wasting away."

The role of the SLP will change over time due to the progressive nature of the dementia disease process and its impact on swallowing function and nutrition. The goal of the SLP is the same as Medicare's # 1 goal, which is "facilitating and maintaining safety for the resident during swallowing and p.o. intake." It is imperative that the SLP has a solid understanding of dysphagia and appropriate treatment and management techniques specific to the disorder.


The goal of assessment for an individual with dementia is to identify the nature of dysphagia, identification of the contributing factors, differentiate the physiological impairment and/or cognitive dysfunction aspects, capacity for safety improvement, and potential to benefit from skilled intervention. Specific components of the initial assessment include chart review, sensory assessment, head and neck positioning, oral-motor skills, pattern of mastication, salivation, and laryngeal elevation. Each of the swallow assessment components are individually reviewed with specific areas identified for review:

Chart Review

Review of the medical record is absolutely essential for determining the disease process or combination of factors that are related to the presence of dysphagia. The course of recovery or progressive decline found in the diseases and surgical procedures linked to dysphagia vary widely. Once the disease process contributing to the dysphagia is identified, the clinician should determine the patient's course of anticipated recovery or decline. The impact of progressive dementia on swallow function can be fairly predictable. Chart review takes on a more primary role when the patient's recall or ability to provide information is limited due to memory impairment, dementia or other language deficit. The following information in the medical record should be referenced:

  • Diagnoses

  • Current weight

  • Recent weight changes

  • Current and historical therapeutic/altered diets

  • Current eating habits including food types and amounts consumed at scheduled and unscheduled times of the day

  • Self feeding skills throughout the course of the meal

  • Eating and chewing difficulties

  • Review of nursing notes for signs/symptoms of congestion, coughing, choking with drinking, taking medications, fever, lethargy.

  • X-ray results - Chest, MBS

  • History of pneumonia

susan m curfman

Susan M. Curfman, MA, CCC-SLP

Sue Curfman has been in the field of healthcare for 30 years with experience across the continuum of care including acute hospital, inpatient rehab, home health, outpatient and skilled nursing.  She is a speech pathologist by training and serves as the Assistant Vice President for Post Acute Services at Saint Anthony’s Health Center in Alton, IL. She is responsible for the clinical, operational and fiscal management of inpatient rehab, skilled nursing, home health, hospice, adult day care and outpatient therapy services.  Sue also holds certificates in Case Management and Quality Management.

The presenter has no financial considerations or relationships with any products related to this presentation.

Related Courses

Documenting to Demonstrate Skilled Service and Focus on Function
Presented by Nancy B. Swigert, MA, CCC-SLP, BCS-S


Nancy B. Swigert, MA, CCC-SLP, BCS-S
Course: #6227 1 Hour
  'Very good information, although dated now, I believe is still relevant in today's speech language pathology work environment'   Read Reviews
In this changing health care environment, the SLP should work closely with the patient in establishing goals that focus on function and aim to achieve the desired, measurable outcome. Medicare guidelines stipulate that services must be provided at a level of complexity requiring the services of a speech-language pathologist. Even when Medicare guidelines are followed in the provision of services, the documentation sometimes does not demonstrate the focus on function or that a skilled service was provided. This course will address how to write measurable, functional goals and provide tips on how to accurately document skilled services.

Medicare Muscle: Creating Defensible Documentation
Presented by Lorelei O'Hara, M.A., CCC-SLP


Lorelei O'Hara, M.A., CCC-SLP
Course: #6346 1 Hour
  'As a CF, this was a great introduction to documentation'   Read Reviews
As claim scrutiny increases, it becomes critical that rehab professionals understand Centers for Medicare & Medicaid Services (CMS) requirements, and how to craft content that shows how our services met those requirements. This course will teach the requirements for services to be reimbursable by Medicare, as well as how to present SLP services through quality documentation.

Cranial Nerves and Dysphagia: Making the Connection
Presented by Tiffani Wallace, M.A., CCC-SLP, BCS-S


Tiffani Wallace, M.A., CCC-SLP, BCS-S
Course: #6705 1 Hour
  'Great resource'   Read Reviews
The course will review cranial nerves along with their function, which are important assessment considerations during a clinical swallowing evaluation.

Dysphagia in Neurodegenerative Disease: Focus on ALS and Parkinson’s Disease
Presented by Debra Suiter, PhD, CCC-SLP, BCS-S


Debra Suiter, PhD, CCC-SLP, BCS-S
Course: #6760 1 Hour
  'The research supporting her claims and how applicable that information was to clinical practice'   Read Reviews
Patients with neurodegenerative diseases often experience significant difficulty swallowing. This course will review information specific to dysphagia in individuals with amyotrophic lateral sclerosis (ALS) and individuals with Parkinson’s disease. Evidence-based evaluation and treatment methods specific to these two patient populations will be discussed.

Vanderbilt SLP Journal Club - Patient-Reported Outcome Measures in Medical Speech-Language Pathology
Presented by Barbara Jacobson, PhD, CCC-SLP


Barbara Jacobson, PhD, CCC-SLP
Course: #6853 1 Hour
  'Good examples of materials that can be used'   Read Reviews
This course is designed to introduce the clinician to the range of patient self-report measures for a variety of communication and swallowing disorders. Participants will understand the basic development of these measures and their application to clinical practice.