Dysphagia Quiz 8 👅

CARES tool

Caregiver Analysis of Reported Experiences with Swallowing Disorders. A 26-item screening tool designed to identify caregiver burden. high score bad.

CARES Cut Score

A total score of 4 or more on the CARES indicates the caregiver needs some extra support. (positive screening result for swallowing-related caregiver burden)

Swallowing-Related Caregiver Burden

The overall strain that caregivers experience as a result of managing a loved one's swallowing issues.

CARES Part A vs. Part B

Part A = Checklist of Behavioral and Functional Changes (objective; scored out of 10).

Part B = Measures of Subjective Caregiver Stress (scored out of 16).

EAT-10 (Eating Assessment Tool-10)

A 10-item patient-reported outcomes tool measuring perceived swallowing impairment. Scored on a Likert scale (0–4 per item). A score of over 3 suggests the presence of dysphagia. high score bad.

IDDSI-FDS tool

A tool used for measuring the degree of diet texture restriction. Scores range from 0 (nothing by mouth) to 8 (unmodified diet). low score bad.

ZBI (Zarit Burden Interview) tool

A 22-item self-report tool used for measuring general caregiver burden.Total scores range from 0–88. Originally used for dementia population but is used across many neurodegenerative diseases.

Why Is Water Considered Safer to Aspirate?

Regular water has very few harmful bacteria in it. If a small amount gets into the lungs by accident, the lungs can actually absorb it into the bloodstream.

Who can you not use the Frazier Free Water Protocol on?

patients w/ neurodegenerative conditions, low mobility, or poor oral hygeine

Decision-Making Capacity (DMC)

Whether or not a person is mentally able to make a particular medical decision for themselves. Needs to pass the four criteria:

1. communicate a choice (“I have decided that I do not want the surgery.”)

2. understand relevant information (“The doctor said this medication will lower my blood pressure if I take it everyday.”)

3. comprehend risks and benefits (“If I don’t take this medicine, I could have a stroke.”)

4. manipulate information rationally. (“Even though surgery could fix the problem faster, I prefer medication.”)

Different from legal "competence," which is a global court-determined status.

Informed Consent vs. Informed Refusal

Informed consent = a patient fully understands their options and the risks involved, and then agrees to a treatment plan.

Informed refusal = A patient fully understands everything and says no. Adult patients have the right to refuse any treatment, even if saying no could kill them.

Assent

A weaker form of consent, used in routine clinical procedures where refusal is not expected from the patient. Doesn't fully protect the clinician legally.

Advance Directives

Legal documents that allow a person to specify treatment preferences in advance, in case they lose decision-making capacity.

1. Living Will: specifies which life-prolonging interventions they wouldn’t want.

2. DPAHC: names a surrogate decision maker

Surrogate Decision Maker

The person who makes medical decisions on behalf of a patient who lacks DMC. Priority order: spouse → adult child → parent → adult sibling → other adult (friend/neighbor)

Nasogastric and gastrostomy tubes do NOT eliminate….

aspiration of saliva or other oral secretions

As the body begins shutting down, loss of ____ and reduced interest in _____ ______are natural and expected.

appetite, oral intake

Ketosis at End-of-Life

When the body runs out of its usual fuel source (glucose), it switches to burning fat instead. This produces chemicals called ketones, which have been linked to feelings of euphoria. Some researchers believe this natural shift may actually make the dying process more comfortable.

SLP Role at End-of-Life

goal is comfort and quality of death, not restoration of function. Appropriate SLP interventions may include: oral care recommendations, comfortable positioning, feeding guidance

Multidisciplinary Team and CARES Implementation

Full implementation of the CARES requires collaboration across SLPs, counselors, dietitians, nurses, physicians, social workers, and spiritual care providers. (only need to name two or three)

Death Rattle vs. Terminal Restlessness

Death rattle = gurgling sound from secretions in the airway.

Terminal restlessness = agitated delirium.

Supplemental Hydration at End-of-Life

Current evidence suggests supplemental fluids may not help, and may actually worsen the dying experience.

"Actively Dying" Defined

When death is expected within hours to days. Common signs include fatigue, loss of appetite, or declining oral intake.