DYSPHAGIA AND DIETARY LEVELS IN SKILLED NURSING FACILITIES

OBJECTIVE: To determine the appropriateness of dietary levels of residents with suspected feeding and/or swallowing disorders. DESIGN: Chart review, evaluation, intervention, observation. SETTING: Two skilled nursing facilities, one in Washington, one in Florida. SUBJECTS: Two hundred twelve residents, mean age 72.9, suspected of having feeding and/or swallowing disorders. MEASUREMENTS: After documentation of dietary level, each resident on a mechanically modified diet was given an evaluation by a speech/language pathologist specific to their feeding and swallowing skills. Changes in the dietary level were made, and the residents were followed for 30 days to evaluate their response. RESULTS: Thirty-one percent of the residents in the two facilities were prescribed a mechanically altered diet. Ninety-one percent were at dietary levels below that which they could tolerate safely; four percent were at dietary levels higher than they could tolerate; five percent were considered to be at the appropriate diet level. CONCLUSIONS: Many nursing home residents may be inappropriately placed or maintained on mechanically altered diets. Regular reevalution of their dietary level is necessary because most may be able to eat safely at higher levels. Active participation by speech/language pathologists knowledgeable in the assessment of oropharyngeal dysphagia is helpful in this process.