THE MEDICALLY COMPLEX PATIENT
•Respiratory issues and swallowing
•Cognitive deficits including dementia and mental illness
•Esophageal issues
•Infections
•Cancers
•Medication effects
DIAGNOSIS
•Assessing respiration and airway
?respiratory rate
?dyspnea and shortness of breath
?coordination of breathing and swallowing
?respiratory muscle strength
?oxygen saturation
?homeostasis
?cough
•Clinical assessment
•Instrumental assessment
•Assessing aspiration tolerance/pulmonary clearance
?respiratory status
?nutritional status
?oral hygiene
?medical issues
?dependency issues
?cognition
?mobility
?endurance
•Esophageal issues
?GERD
?constipation
?esophageal dysphagia
•Understanding swallow variability
?laryngeal penetration (and aspiration)
?dwell times
?normal aging
?residue
MANAGEMENT ISSUES
•Diet management: texture, thick liquids, water
•Tube feeding: When? Who?
•Improving breathing/swallow coordination
•Exercise: When does it work?
•Oral hygiene strategies
•Cognition
•Managing endurance issues
•Medication administration
END OF LIFE ISSUES
Case discussion