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. 2025 Feb;21(2):e70028.
doi: 10.1002/alz.70028.

Eating and swallowing care disparities in persons with dementia: A conceptual framework

Raele Donetha Loy  1   2 , Nicole Rogus-Pulia  1   2   3 , Fred Ketchum  2   4 , Michelle Troche  5 , Anaïs Rameau  6 , Harrison N Jones  7 , Luis Riquelme  8   9   10 , Andrea Gilmore-Bykovskyi  11 , Manish N Shah  11 , Amy Kind  1   2
Affiliations

Eating and swallowing care disparities in persons with dementia: A conceptual framework

Raele Donetha Loy et al. Alzheimers Dement. 2025 Feb.

Abstract

Introduction: Eating and swallowing difficulties are prevalent and distressing among persons living with dementia (PLWD). These challenges may be especially burdensome for PLWD in lower-resourced settings, where environmental factors such as social support, health-care infrastructure, and food access are critical for meeting quality standards of eating and swallowing care. However, clinical practices and research methods have not sufficiently focused on the lived environment to promote high-quality, socially and culturally aligned management approaches.

Methods: To address this gap, we developed a conceptual framework informed by the literature, grounded in ecological systems and fundamental cause theories, and refined through iterative discussion.

Results: Our framework highlights individual-, system-, and community-level factors and resources influencing person-centered eating and swallowing care for PLWD. It identifies areas at risk for inequitable care along the swallowing management continuum.

Discussion: We propose future research areas to help health-care providers reconcile the demands of eating and swallowing care with the lived realities of PLWD.

Highlights: There are eating/swallowing care disparities among persons living with dementia. We introduce a conceptual framework applying social and structural determinants of health to eating/swallowing care. We also recommend areas to address disparities and improve eating/swallowing care.

Keywords: Alzheimer's disease; dementia; dysphagia; health equity; social determinants of health.

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Conflict of interest statement

Dr. Rogus‐Pulia is a VA employee and this work was partially supported by the William S. Middleton Veteran Affairs Hospital, Madison, WI, USA (X placeholders Manuscript 05‐2025). The content and views expressed in this article are those of the authors and do not necessarily reflect the position or official policies of the United States Government or the US Department of Veterans Affairs. Dr. Troche receives royalties from MedBridge, Inc. Dr. Rameau owns equity in Perceptron Health Inc. She is also a medical advisor for Sound Health Inc. Author disclosures are available in the supporting information.

Figures

FIGURE 1
FIGURE 1
A novel conceptual framework of structural and social determinants of eating and swallowing care disparities in PLWD. PLWD, persons living with dementia; SLP, speech–language pathologist.
See this image and copyright information in PMC

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