Review diet for adequate fiber and fluid intake, and check for medications that may contribute to constipation

Evaluate wheelchair seating to ensure the patient's nose, umbilicus, and knees are facing the same direction, which may help with bowel motility and a strong Valsalva maneuver

Prescribe exercise; even passive knee to chest range of motion can improve bowel motility

Teach supporters to position themselves behind the patient when providing oral care, with the patient's head held back and to the side to protect the airway

Consider prescribing bite blocks to prop open the mouth

Consider recommending adaptive toothbrushes; water pic and suction; xylitol gum or spray; antimicrobial agents, such as chlorhexidine (Peridex); and clearing food and rinsing the mouth with water after meals

Assess the patient's diet for sugar and acidic foods to reduce caries and erosion of enamel

Customize seating for wheelchair users to reduce pressure points and provide support

Assess for occult fractures, which can easily be missed in patients with communication difficulties

Instruct supporters to lift from the patient's core rather than extremities to prevent fragility fractures

Prescribe exercise for maintaining strength and range of motion

Consider prescribing calcium and vitamin D supplements for the prevention of osteoporosis, especially if there are risk factors such as wheelchair use, nutritional problems, use of medications that inhibit absorption, or limited exposure to sunlight

Monitor for signs of osteoarthritis

Consider recommending a wheelchair for longer outings if gait is abnormal to preserve joints

Treat gastroesophageal reflux, which may present as cough (as well as erosion of tooth enamel)

Recommend upright positioning to reduce aspiration risk

For patients with dysphagia, consider ordering a swallow study to optimize food texture and feeding procedure to prevent aspiration

Consider prescribing a nebulizer for inhaled medication in patients who cannot use metered dose inhalers correctly

Assess for occult spinal cord and peripheral nerve compression, which can easily be missed in persons with communication and baseline functional limitations

Assess for dementia

Assess for treatable medical conditions that can be misdiagnosed as dementia

Prescribe exercise to maintain strength and range of motion, especially during hospitalizations and illnesses

Prescribe rehabilitation for any loss of function from deconditioning, especially after hospitalization

Consider ordering a pressure-reducing mattress

Treat rashes promptly

Manage excessive saliva

Train patients and supporters on protocols to maintain good hygiene

For patients who pick at skin, evaluate boredom or anxiety and explore possible replacement behaviors