TASTINGS
I noticed a trend a few years ago, when working as the SLP for a
subacute rehabilitation unit within a Midwestern general hospital. Older
patients, both those on my caseload and those not, were turning up their noses
at the salt-restricted diet prescribed during their rehabilitation stay. The
patients often not on my caseload were cared for by orthopedic surgeons. They
had undergone either hip or knee replacement; a fractured femur
or tibia. It often wasn’t that the patients were struggling to swallow their
food. It wasn’t that dementia had taken hold of their drive to eat and drink.
There were also few signs, in the majority of cases, that these patients were
in the throes of another acute disease (cancer), or a degenerative (PD, MS,
ALS) or chronic (late effects of stroke or TBI) condition. In the majority of
cases, the food simply did not taste good to the patient. I wondered how often
this happened.
It did not matter if the patient had entered
rehabilitation with medical restrictions on her/his diet, or that it had been newly
prescribed following surgery. The patient may or may not have demonstrated her understanding
to the doctor, that salt included in the diet had become a mechanical load
prohibiting good general health. When the food did not taste as good as they
wanted, they ate less.For those persons with diabetes who are also refusing to eat, there is then
a crisis of medical management. You may say that such a situation is outside
the SLP’s scope of practice, and our caseloads are bulging as it is. In many
worksites, that may be true.
The SLP’s unique skill set for training behavior change, together with
the knowledge base the field has achieved in dysphagia management, may give
her/him an advantage to help meet a need for persons on salt-restricted diets. A
clinician’s powers of observation may help her/him see signs of the
noncompliance first: Fast food bags in the trash can; salt shakers pushed back
to the corner of a drawer; or hushed negotiations by patients in the hallways
for ‘black market salt’. And so, you’ve identified these persons who want
little to do with salt restrictions.
There are a cadre of professional staff (nurses, nutritionists, doctors)
educating them on the risks of neglecting sodium restrictions. Persons who are
enabling the patient to get salt are concerned about the patient’s comfort during
their hard rehab work. The SLP, with some assistance from the rehab team, may
contribute some practical answers.
An occupational therapist and I led this group activity in a subacute
rehabilitation program, so a shout out goes to the late Mara Chiocca, OTR/L. Patients in this group, who had expressed an
interest in gardening, not only harvested some fresh herbs but also used the
herbs to prepare a spread, sampled on crackers as a “tasting”. It wasn’t always
great cooking, but it became a lot of fun for all.
Not only can it
facilitate older adults’ adaptation to diet changes, but also stimulate
cognitive processing and psychosocial interaction, and encourage return to
leisure activities after discharge. Here is a re-creation of how we did it.
The herbs were harvested immediately prior to preparation –
in this case, from the Aero Garden planters that were positioned in corners of
our multipurpose activity room.
It is atypical for an SLP to be requested to treat orto pts. Who would pay for this and how does an herby spread on crackers reduce salt intake?
ReplyDeleteOrtho, sorry
ReplyDeleteThe SLP did not bill for the ortho patients, but OT did. There were patients with cognitive impairment also included in the group, whom SLP assisted during the period. Regarding the use of herbs, check out http://www.aarp.org/food/diet-nutrition/info-12-2010/healthy_herbs_and_spices.html - for some ideas. Thanks again for the comments.
ReplyDelete