Perspectives of Hospital Medicine Providers on the Management of Oropharyngeal Dysphagia in Patients with Dementia.

Background: Oropharyngeal dysphagia (dysphagia) is a common (up to 86%) and devastating syndrome in hospitalized older adults with dementia.

Objective: To describe the perspectives of dysphagia management in hospitalized patients with dementia among hospital medicine providers (i.e., hospitalists, internal medicine residents, and advanced practice providers, APPs).

Design: An anonymous cross-sectional survey study across a large health system in the greater New York metropolitan area PARTICIPANTS: Surveys were distributed to hospitalists, internal medicine residents, and APPs via a multimodal approach. Survey questions were created by an interprofessional team consisting of hospitalists, a geriatrician, and a geriatrics-trained APP.

Main Measures: Survey questions assessed current practices and perceptions of dysphagia management in patients with dementia.

Key Results: Of 104 surveys completed, 62.1% were hospitalists, 24.3% were APPs, and 13.6% were residents. Nursing report (61.0%) was the most common way providers found out about suspected dysphagia. The vast majority (85.0%) always/often consulted a Speech-Language Pathologist (SLP) for suspected dysphagia evaluation. Over a third (39.8%) rarely/never discussed goals of care before consulting a SLP. Provider perceptions of the risks/benefits of dysphagia diets varied widely: dysphagia diets in patients with dementia improve quality of life (strongly disagree/disagree 33.0%, neither agree or disagree 31.1%, strongly agree/agree 35.9%); dysphagia diets in patients with dementia reduce the risk of mortality (strongly disagree/disagree 33.0%, neither agree or disagree 22.3%, strongly agree/agree 44.7%). Lastly, only 64% thought there was enough evidence to recommend against a PEG in patients with advanced dementia.

Conclusion: Our study highlights the need for standardizing dysphagia management best practices in hospitalized patients with dementia, the importance of addressing goals of care, and provider education on the risks and benefits of dysphagia diets and artificial nutrition via PEG tube.