Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

March 2015 Independent Eating and Drinking Newsletter

Independent Eating...   is a Wonderful Thing

March Topics:

  • The Causes of Aspiration Pneumonia

  • What does being a Dependent Eater Mean?

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The Causes of Aspiration Pneumonia

Mealtime Partners is dedicated to its vision of providing those who are unable to eat or drink independently, the means to become autonomous in these activities. To enable people to feed themselves and drink whenever they wish, Mealtime Partners has created a line of eating and drinking products that can be used by a wide variety of individuals who need them. However, our highest priority within this mission is to allow these functions to be undertaken safely.

Because there is always some degree of risk of choking, or even worse, aspirating food or liquid when eating and drinking, it is essential that the best possible practices are used during eating and drinking regardless of whether someone is being fed or self-feeding. Because aspirating can lead to aspiration pneumonia, it is important to understand some of the known contributors to causing aspiration pneumonia.

Several research studies have been conducted that evaluate which issues put an individual at risk of developing aspiration pneumonia. This article will briefly describe two of the publications that shed light on some of the risks that relate to aspiration, and will provide links to their source. Readers who are involved with individuals who need assistance with eating and/or drinking are encouraged to read the articles as they provide a wealth of valuable information. This Newsletter article will provide a synopsis of these findings.

Langmore S.E., Terpenning M.S., Schork A., Chen Y., Murray J.T., Lopatin D., Loesche W.J: Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia, 13:69-81 (1998).

Langmore, et al. identified and evaluated the relative risk factors for aspiration pneumonia including dysphagia. They include:

Medical/health status – despite stroke and other neurological diseases being historically associated with the highest occurrence of aspiration pneumonia in individuals who have a compromised health status, the study found that chronic obstructive pulmonary disorder (COPD), gastrointestinal disease and congestive heart failure had comparable rates of occurrence of aspiration pneumonia.

Functional status – Declining functional status can be associated with health status. Dependency for care increases as health declines. Even though this article does not specifically address the number of activities of daily living for which assistance or complete care are needed, the study identified dependence for feeding and oral care to be significantly related to the occurrence of pneumonia while reduced level of alertness showed no noteworthy increase in its occurrence despite being identified as an issue in other studies. The study concluded that dependence for eating was a strong indicator of the occurrence of aspiration pneumonia because those who are fed, and who develop aspiration pneumonia, tend to have increased volume of material that is aspirated. This was especially true in patients with dysphagia.

Dysphagia and gastroesophageal reflux status – The study found that there was a significant relationship in the occurrence of pneumonia and those who had a diagnosis of dysphagia and who aspirated. It, as well as several other studies, found that the aspiration of food correlated to a higher incidence of pneumonia than the aspiration of thin liquid. Many of the swallowing difficulties associated with dysphagia could be associated with aspiration. However, the study did not conclude that dysphagia alone caused aspiration pneumonia, but when it occurred with other risk factors, it contributed to an increase in occurrence.

Oral/dental status – The number of decaying teeth, frequency of tooth brushing and being dependent for oral care were significantly associated with pneumonia. More plaque and gingivitis occurred in those who were unable to brush their own teeth. Dental disease may contribute to pneumonia because there is an increase in the bacteria in the mouth and the saliva that may be aspirated.

The study concludes that aspiration pneumonia is multi-factorial and that no single predictor can be identified as the causal factor for the disease. The issues described above are risk factors that contribute to the likelihood of the occurrence of aspiration pneumonia and that some were found to be especially significant predictors, such as dependence for feeding.

Judi Hibberd, Jenni Fraser, Claire Chapman, Hannah McQueen, Adrian Wilson. Can we use influencing factors to predict aspiration pneumonia in the United Kingdom? Multidisciplinary Respiratory Medicine, 2013, 8:39.

This study, built on the previously discussed study, looked at the influencing factors of aspiration pneumonia in those with swallowing disorders in the United Kingdom. The study found that there were 13 statistically significant factors implicated in developing aspiration pneumonia. Nine factors correlated with the Langmore, et al. study findings. They included: poor mobility, being fed by tube rather than by mouth, age, dependency in feeding, number of medications, Chronic Obstructive Pulmonary Disease (COPD), number of different medical conditions (occurring simultaneously), stroke and alcohol abuse. The article Discussion section addressed the influence of feeding ability and concludes that dependency for eating, eating by mouth only, and dysphagia influences the occurrence of aspiration pneumonia.

These articles, and several more that have been published in an array of peer reviewed journals, indicate that there are several identified causes for the development of aspiration pneumonia. Relative to eating and drinking, the fact that someone is dependent upon another person to feed them and provide them with a drink, in association with other causes, such as dysphagia, can increase the likelihood of the development of aspiration pneumonia. The lesson that can be taken from this information is that feeding someone is not an easy, risk-free task. Care providers, both professional and family members, should receive guidance from clinicians as to how to best perform these responsibilities.

Next month’s Newsletter will expand the discussion about causes of aspiration pneumonia by providing information about a research study that examined the impact upon swallowing of different methods of food presentation such as self-feeding, being fed by another person, and self-feeding with the Mealtime Partner Dining System, and will also discuss how eating and swallowing differ depending upon the method of consumption.

The Front Mounted Drinking System can be customized to meet the unique needs of specific users. Not only can it be purchased with different length Flex Arms (6”, 12”, 18”, 24” and 30”) but its Mounting Clamp allows it to attach to a variety of locations on a wheelchair: handles, arm supports, etc. This allows the Cup Holder to be positioned in the most appropriate location for access by the user. The Cup Holder can hold many different containers including a coffee mug, a water bottle, and a can of soda. (It comes with a removable Koozie.) Because it accommodates user provided containers, cleanup is easy. Simply put permanent containers in the dishwasher and discard the disposable containers when the container is empty!
Front Mounted Drinking System   Front Mounted Drinking System
The Front Mounted Drinking System is shown with a 30” Flex Arm on the left and a 18” Flex Arm on the right. They are clamped to different locations on the wheelchair illustrating the flexibility of how the drinking system can be mounted on a wheelchair. Additionally, the Cup Holder is shown with a plastic cup with lid and an insulated coffee cup. The Front Mounted Drinking System is like having a custom drinking system!

For more information about this drinking system, or to order, click here.
The Front Mounted Drinking System is only available from Mealtime Partners, Inc.

What does being a Dependent Eater Mean?

The term dependent eater occurs frequently in journal articles. It is a concise term that appears to graphically describe its meaning. However, when it is used by health insurance companies the meaning expands significantly. This article will briefly describe the need to provide further explanation when dependent eater is used in some contexts.

In journal articles the term dependent eater is consistently used to describe an individual who is unable to feed themselves and who must be fed by another person. It is limited to the task of food being provided to the person: the care provider picks up food either with a utensil or their fingers and places it in the dependent eater’s mouth. The term is limited to that task.

Yet many health insurance companies expand the meaning of dependent eater to include a great many more tasks than the single task described in the previous paragraph. It is important to understand the difference in usage of the term and the interpretation of the meaning to avoid allowing health insurance companies to misunderstand the abilities and limits of a dependent eater. In many cases, when equipment to remediate the need to be fed is requested from a health insurance provider by an individual who is a dependent eater, the request will be denied. The insurance provider conceives of the task of eating to include many more tasks than the single task of putting food in someone’s mouth.

To fully grasp a health insurance company’s interpretation of the term “dependent eater”, a discussion of other commonly used terms is appropriate. According to the U. S. Department of Health and Human Servicesthe term "activities of daily living," or ADLs, refers to the basic tasks of everyday life, such as eating, bathing, dressing, toileting, and transferring. When people are unable to perform these activities, they need help in order to cope, either from other human beings or mechanical devices or both.” According to this definition, eating is an ADL.

Instrumental Activities of Daily Living or IADLs refer to a series of life functions necessary for maintaining a person's immediate environment. They include managing money, shopping, telephone use, travel in the community, housekeeping, preparing meals, and taking medications correctly. ( Therefore, preparing food is classified as an IADL.

Health insurance companies mix these functions together, which is an error on their part. They, in many cases, do not separate eating and food preparation. Being a dependent eater requires that you must have an alternative way of consuming food because you are unable to feed yourself. Eating is a basic function of life and if you do not eat food, you will starve. However, when a request for assistive technology for eating is received, many health insurance companies decide that because someone is cooking for the person who is a dependent eater, the same person could feed the dependent eater. They do not recognize that food preparation and feeding someone are totally separate tasks. Someone who cooks is not necessarily trained, have the time, or be willing to feed another person. More importantly, the dependent eater is considerably safer feeding themselves than being fed (as noted in the previous article). If the dependent eater and their medical team deem that durable medical equipment that facilitates independent eating is medically appropriate, how food is prepared, or who prepares it, should not be part of the health insurance company’s consideration for approval.

An easy to understand analogy is: If you are unable, or have difficulty walking, you will be provided with a wheelchair by your health insurance company. The wheelchair facilitates your being able to be mobile. You are not expected or required to be able to plug in a charger for a power wheelchair, nor are you expected to be able to fasten your own seatbelt to be able to receive a wheelchair. It is accepted practice that you will have assistance to get into and out of your wheelchair and fastening the seatbelt, if you need it. However, once you are situated properly in your wheelchair you can become independently mobile. With a dining device, once you are situated properly with food cut up and put in the bowls, you can eat independently. The two activities of daily living are comparable in this way.

Being a dependent eater is exactly what it sounds. Health insurance providers and any other institutions who interpret the meaning of the expression should not, for their own convenience and monetary savings, expand the meaning to the detriment of the dependent eater.

Did You Know? Did you know that a “dry swallow” isn’t dry? People commonly describe dry-swallowing pills. This means that they put the pills into their mouth and, without a drink, they swallow the pills. A dry swallow is the same thing. It occurs when we intentionally create a swallow without taking a drink. Typically, when this happens we will swallow some saliva. However, if you suffer from Xerostomia, or dry mouth, and your salivary glands do not make enough saliva to keep your mouth moist, you will have problems being able to complete a dry swallow. Chewing, swallowing, and tasting food or drinks are difficult if you have a dry mouth. Alternately, dry swallows are encouraged for those who have the opposite problem: drooling or sialorrhea (i.e., excessive saliva). They are encouraged to intentionally swallow more frequently than their body typically automatically does. This helps to control the volume of saliva in their mouth and to reduce spillage of saliva from the mouth.

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