Eating Problems in Advanced Dementia: Navigating Difficult Conversations

Introduction The majority of older adults with advanced dementia (AD) develop difficulties with eating and swallowing, often prompting concerns about nutrition and quality of life. Employing a palliative approach requires providers to attain skills in addressing symptoms and communicating with famil...

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Autores principales:	Erika R. Manu, James T. Fitzgerald, Patricia B. Mullan, Caroline A. Vitale
Formato:	article
Lenguaje:	EN
Publicado:	Association of American Medical Colleges 2020
Materias:	Resident Education Palliative Care Education Geriatrics Education Advanced Dementia Dysphagia Geriatrics Medicine (General) R5-920 Education L
Acceso en línea:	https://doaj.org/article/3e4dced757aa4a18af7420b66b8f2792
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spelling	oai:doaj.org-article:3e4dced757aa4a18af7420b66b8f27922021-11-19T15:13:21ZEating Problems in Advanced Dementia: Navigating Difficult Conversations10.15766/mep_2374-8265.110252374-8265https://doaj.org/article/3e4dced757aa4a18af7420b66b8f27922020-11-01T00:00:00Zhttp://www.mededportal.org/doi/10.15766/mep_2374-8265.11025https://doaj.org/toc/2374-8265Introduction The majority of older adults with advanced dementia (AD) develop difficulties with eating and swallowing, often prompting concerns about nutrition and quality of life. Employing a palliative approach requires providers to attain skills in addressing symptoms and communicating with family caregivers about the trajectory of AD and associated dysphagia, as well as to elicit goals of care. Research suggests internal medicine (IM) residents often perceive minimal education during training addressing skills needed to care for patients with AD. Methods We developed and piloted a small-group interactive seminar utilizing a trigger video depicting a family meeting addressing eating problems in a patient with AD. Case-based learning, small-group discussion, and learner reflection were employed. We assessed the impact on 82 of the 106 IM, medicine-pediatrics, and neurology residents who participated in the seminar. Results Participant evaluation indicated residents showed high satisfaction and perceived the educational content of the seminar to be robust and clinically relevant. We found statistically significant (p < .001) improvements in self-reported confidence in dementia-specific skills postseminar. Effect size was large to very large (Cohen's d = 1.3-1.7). Discussion An interactive, case-based seminar utilizing a video depicting a realistic family meeting improved residents' self-efficacy in skills needed to address nutritional issues, engage in goals-of-care discussions, and reflect on concerns among caregivers of patients with AD. The seminar teaches important geriatric and palliative concepts meant to improve residents' ability to care for older adults with AD in their future careers.Erika R. ManuJames T. FitzgeraldPatricia B. MullanCaroline A. VitaleAssociation of American Medical CollegesarticleResident EducationPalliative Care EducationGeriatrics EducationAdvanced DementiaDysphagiaGeriatricsMedicine (General)R5-920EducationLENMedEdPORTAL, Vol 16 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Resident Education Palliative Care Education Geriatrics Education Advanced Dementia Dysphagia Geriatrics Medicine (General) R5-920 Education L
spellingShingle	Resident Education Palliative Care Education Geriatrics Education Advanced Dementia Dysphagia Geriatrics Medicine (General) R5-920 Education L Erika R. Manu James T. Fitzgerald Patricia B. Mullan Caroline A. Vitale Eating Problems in Advanced Dementia: Navigating Difficult Conversations
description	Introduction The majority of older adults with advanced dementia (AD) develop difficulties with eating and swallowing, often prompting concerns about nutrition and quality of life. Employing a palliative approach requires providers to attain skills in addressing symptoms and communicating with family caregivers about the trajectory of AD and associated dysphagia, as well as to elicit goals of care. Research suggests internal medicine (IM) residents often perceive minimal education during training addressing skills needed to care for patients with AD. Methods We developed and piloted a small-group interactive seminar utilizing a trigger video depicting a family meeting addressing eating problems in a patient with AD. Case-based learning, small-group discussion, and learner reflection were employed. We assessed the impact on 82 of the 106 IM, medicine-pediatrics, and neurology residents who participated in the seminar. Results Participant evaluation indicated residents showed high satisfaction and perceived the educational content of the seminar to be robust and clinically relevant. We found statistically significant (p < .001) improvements in self-reported confidence in dementia-specific skills postseminar. Effect size was large to very large (Cohen's d = 1.3-1.7). Discussion An interactive, case-based seminar utilizing a video depicting a realistic family meeting improved residents' self-efficacy in skills needed to address nutritional issues, engage in goals-of-care discussions, and reflect on concerns among caregivers of patients with AD. The seminar teaches important geriatric and palliative concepts meant to improve residents' ability to care for older adults with AD in their future careers.
format	article
author	Erika R. Manu James T. Fitzgerald Patricia B. Mullan Caroline A. Vitale
author_facet	Erika R. Manu James T. Fitzgerald Patricia B. Mullan Caroline A. Vitale
author_sort	Erika R. Manu
title	Eating Problems in Advanced Dementia: Navigating Difficult Conversations
title_short	Eating Problems in Advanced Dementia: Navigating Difficult Conversations
title_full	Eating Problems in Advanced Dementia: Navigating Difficult Conversations
title_fullStr	Eating Problems in Advanced Dementia: Navigating Difficult Conversations
title_full_unstemmed	Eating Problems in Advanced Dementia: Navigating Difficult Conversations
title_sort	eating problems in advanced dementia: navigating difficult conversations
publisher	Association of American Medical Colleges
publishDate	2020
url	https://doaj.org/article/3e4dced757aa4a18af7420b66b8f2792
work_keys_str_mv	AT erikarmanu eatingproblemsinadvanceddementianavigatingdifficultconversations AT jamestfitzgerald eatingproblemsinadvanceddementianavigatingdifficultconversations AT patriciabmullan eatingproblemsinadvanceddementianavigatingdifficultconversations AT carolineavitale eatingproblemsinadvanceddementianavigatingdifficultconversations
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Eating Problems in Advanced Dementia: Navigating Difficult Conversations

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