[Dysphagia] PSP - no feeding tube

[jvzlvz at hotmail.com (Linda Vande Zande)]

Hi, I'm a speech path fairly new to geriatrics, currently working with a pt 
who has Supranuclear Palsy.  I've downgraded her diet to thickened liquids 
and purees and she is beginning to have trouble even on this.  She has 
advance directives that state no feeding tube.  She cannot communicate and 
is wheelchair dependent.  The family will soon need to know what their 
options are.  I'm not sure what they are.  Some considerations include: 1. 
we can continue to feed her despite her struggle with oral feeding 
(difficult for everyone involved and will likely result in infection ... and 
should we have a nurse standing by ready to suction?)  2. We limit the 
amount of time given to feeding (one hour/3x/day) despite the limited amount 
she will be able to take in (or do we ask a CNA to continually feed her?) 3. 
We stop oral feeding and provide medication for comfort (when?).  Any 
guidance on this is appreciated.  THank you! lindav