Meet Margaret
Margaret Ellis
Margaret Ellis is an 82-year-old resident living in a skilled nursing facility following a stroke that resulted in dysphagia. Following an instrumental swallowing assessment, she was advised to consume nectar-thick liquids (IDDSI Level 2) and a puree diet (IDDSI Level 4).
Margaret is cognitively intact and has been deemed competent to make her own medical decisions (Department of Elder Justice Initiative, 2022). She can explain the risks associated with aspiration, including pneumonia, choking, hospitalization, and possible death (Parth Shah, et al, 2023).
Despite this, she repeatedly states that she does not want thickened liquids or pureed solids.
Margaret misses:
coffee
iced tea
eating meals with her family
the comfort and enjoyment associated with food and drink
She tells her speech-language pathologist:
“I understand the risks. But I would rather enjoy my life than spend the rest of it drinking thickened coffee.”
Margaret views eating and drinking as more than medical interventions (Smith et al, 2023). To her, they represent her cultural identity, comfort, dignity, pleasure, and social connection.
After the recommended diet was implemented, Margaret exhibited a significant decrease in oral intake. Her family reports that she hasn’t been as vibrant as she usually is and that they think she’s depressed. They worry that she may develop dehydration or malnutrition because of not wanting to drink thickened liquids or eat pureed solids.