130 CHAPTER 8 | Maintaining Independent Dining Skills are thirsty.28
Visual field cuts and unilateral neglect may limit independent dining, as the older adult may not see items on one side or may ignore the affected limb and the affected side of space.28
Older adults
who have had a CVA may have decreased sensation to temperature, placing them at risk of injury from hot foods and beverages. Impulsivity or poor judgment are often factors for persons who have had a CVA
affecting the left side of the body. This may place an older adult at risk of choking due to taking large bites or eating and drinking at a rapid pace.28,29
A CVA can
also result in aphasia, or the loss of language skills.28 Older adults with aphasia may be unable to compre- hend verbal speech, including directives and cues; they may also have difficulty with expressing or may be unable to express their wants and needs.
Box 8.5 Interventions for Dysphagia and Deficits Associated With Cerebrovascular Accident13,26,28,29
Impulsivity and poor judgment Supervise the older adult. Put utensils down between each bite. Provide a small-bowled spoon to limit bite size.
Provide flow-control cups or cups with lids and small openings, and present one food item at a time in individual bowls or on small plates.
Decreased attention Provide a quiet environment.
Limit excess noise and visual stimulation.
Unilateral neglect or visual field cut Position food and utensils within the older adult’s available visual field—that is, place all items to the right of midline for an older adult with leſt neglect.
Sit on the affected side, and provide verbal and physical prompts to direct attention to the affected side.
Monitor for pocketing of food and drooling.
Aphasia Consult with speech therapy to establish and use available communication strategies.
Hemiplegia
Consult with occupational therapy and physical therapy for proper positioning.
Incorporate the affected arm by using the affected hand to stabilize the plate.
Use a two-handed technique (if deemed appropriate by therapy) to grasp cups and mugs.
Place the affected arm forward on the table, next to the place setting to assist in maintaining an upright symmetrical posture.
Encourage the older adult to use available active movement by using the affected hand to bring finger foods to the mouth.
Facial weakness
To increase control, provide foods with the appropriate consistency, such as pureed or ground foods with sauces, and liquids with the appropriate thickness.
Place food on the stronger side, tilt head to the stronger side, and assist the older adult with lip closure.
Experiment with temperature, as cold temperatures increase muscle tone.
Pocketing of food
Stroke the older adult’s cheek where pocketing is occurring, stroking back and up toward the older adult’s ear.
Use verbal or gesture cues to prompt a tongue or finger sweep.
Slow oral transit or swallow delay Do not offer thin liquids.
Do not use straws.
Cue the older adult to tuck the chin to increase airway protection. Cue the older adult to double swallow. Cue the older adult to rotate the head to the weaker side. Use hot or cold foods vs warm foods.
Coughing aſter swallowing
If permitted by the diet order, alternate between solids and liquids.
Cue the older adult to chin tuck and double swallow or to clear the throat immediately aſter each swallow.
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