To keep from getting the cart before the horse, let's inventory his medical problems:

• Parkinson's disease
• Swallowing disorder secondary to Parkinson's disease
• Situational depression
• Under-nourishment
• The disposition of his living situation

All of these can be addressed, and if not substantially improved, at least palliated.

• Optomize his Parkinson's therapy.
• Treat his depression with counseling and medications, if appropriate.
• Work with family on optimal living arrangements.
• Home nursing and speech therapy.
• Plan for extended day-care or nursing home.
• Improve nourishment; favorite foods, supplements, mechanical soft diet.
• Calculate basic needs then adjust for his condition.
• Address his dysphagia; the basic goals would be:
• Improve function of the affected muscles with specific exercises.
• Prevent further decline of swallowing ability by retraining.
• Prevent aspiration of food and liquids, including saliva.
• Click here are some simple techniques that should help.

Enteral or parenteral feedings may become necessary, but that does not address the issue of his salivary secretions. He still has to be able to swallow them. As his Parkinson's disease progresses, Mr. Robinson will most likely die of an aspiration pneumonia.

Next is a case of a 36 year-old man with significant and unplanned weight loss.