Perspectives on Gerontology

From the Coordinator

Casper, M. — 2008-07-01

Vision and Perception Deficits Associated With Dementia

Robinson, M. — 2008-07-01

Sensory declines represent a broad category of normal age-related changes that can lead to diminished quality of life for the elderly individual, loss of independence, and increased costs for society as a whole (National Institute of Health, [NIH, 1999). As an individual ages, some of the most prevalent sensory losses are those related to vision and perception. According to the National Eye Institute (NEI, 2004), 3.3 million adult Americans have low vision or blindness and this figure is estimated to increase to 5.5 million by 2020. Vision deficits increase with age; sixty-nine percent of the population who are legally blind are those individuals 80 years old and older. Furthermore, as the population ages, so does the prevalence of multiple age-related diagnoses or conditions that effect vision and/or perception, such as diabetic retinopathy, cataracts, age-related macular degeneration, hemianopsia secondary to a stroke, and dementia.

How Did the Doctor Decide? What SLPs Should Know About the Medical Diagnosis of Dementia

Smith, P. A. — 2008-07-01

Even though the speech-language pathologist (SLP) does not assign a medical diagnosis, communication disorders professionals are responsible for the provision of screening and assessment of cognitive/linguistic skills in health-care environments. When a new patient is admitted with a diagnosis of Alzheimer's disease or another dementing condition, or when an existing patient seems to be exhibiting cognitive decline, the SLP should be aware of the procedures that the medical profession suggests for the assignment of this medical diagnosis. Furthermore, an awareness of the co-morbid conditions that can exacerbate cognitive impairments can guide the SLP in making appropriate referrals so that patients' cognitive abilities remain at their highest potential. The purpose of this article is to review the medical literature about the recommended practices for diagnosing Alzheimer's disease and other dementing conditions, to contrast the cognitive impairments that occur with some more common diseases and conditions, and to invite thoughtful reflection on the part of the SLP working with residents who have an Alzheimer's disease or other dementing diagnosis on a face sheet, a care plan, or a list of ICD-9 codes.

Taste and Appetite Loss in the Aged

Henkin, R. I. — 2008-07-01

"My father is 93 years old and has stopped eating (except soup) because of lack of taste. He is in CA and is not strong enough to make a cross country trip. His health is deteriorating because of the lack of nutrition. We are going to start him on Ensure to try to get some nutrition in his system. Do you know of any way he can get help with his condition in California? Thanks, (Name withheld)"

This e-mail was received from a son of a patient who was desperately trying o help his father but did not know what to do for him or to whom to turn for help.

This problem cries out to the geriatric community for both awareness and solution. "Ensure" is a bandage used to cover up a serious and complicated systemic problem that is not being presently addressed. It has never been formally addressed. Perhaps one reason for the lack of awareness and solution is the complexity and multiple aspects of this problem (the extent to which physiology and pathology relate to appetite loss) which has not been brought together in a systematic approach. This article will describe a portion of the entire system with a focus on the sensory qualities of taste and smell, emphasizing the importance of this aspect of this complex system.

Practical Strategies: Nourishing Liquid Diet

Emley, S. J., Gluch, L., Casper, M. — 2008-07-01

The aging population is increasingly subject to dementia. All types and etiologies of dementia result in impaired memory, personality changes, and loss of cognitive function. Success with oral intake is often affected as dementia progresses. The individual with dementia may have issues with self-feeding, recognizing food, maintaining attention, persistence of action, or apraxia—all of which affect the ability to chew and swallow safely and effectively (Advisory Panel on Alzheimer's Disease, 1993). The patient's ability to maintain adequate nutritional status through eating by mouth may be lost as dementia progresses (Chouinard et al., 1998).

Caregivers and professionals may find themselves in a practical dilemma—how to provide nutritional intake and allow the patient to continue to eat by mouth safely and successfully while also overcoming the complicating factors present with dementia. In our organization, our dietitians developed an approach that offers a nutritional alternative to tube feeding—the nourishing liquid diet.