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

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, timed-event 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.

Keywords: Dementia; behavioral symptoms; dysphagia; mealtime; person-centered care.

Conflict of interest statement

Dr. Gilmore-Bykovskyi reports receiving support from the National Harford Centers of Gerontological Nursing Excellence and the American Nurses Foundation Virginia Stone Research Award in Clinical Gerontology. Dr. Rogus-Pulia reports receiving grant funding from the Wisconsin Alzheimer’s Disease Research Center, the American Speech-Language-Hearing Foundation and the Veterans Health Administration’s Office of Geriatrics and Extended Care. Dr. Rogus-Pulia has been remunerated for presentations through the American Speech-Language-Hearing Association (ASHA) and the National Foundation of Swallowing Disorders (NFOSD).

Figures

Figure 1

Lag Sequential Analysis for Caregiver Person-Centered Actions, Task-Centered Actions and Behavioral Symptoms as Antecedents of Aspiration Events

Figure 2

Lag Sequential Analysis for Caregiver Person-Centered Actions, Task-Centered Actions and Behavioral Symptoms as Consequences of Aspiration Events