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Dysphagia and Liquids: To Thicken or Not to Thicken

Dysphagia, defined as difficulty or discomfort with feeding or swallowing, affects the health and quality of life of millions of people, particularly the elderly. An estimated 15 million people in the United States alone suffer from dysphagia,¹ which is common in individuals impacted by stroke, Parkinson's disease, amyotrophic lateral sclerosis (ALS), Alzheimer's disease/dementia, and many other health conditions.³

The condition puts patients at risk for poor nutrition, aspiration pneumonia, and other secondary health issues. It’s a particularly difficult issue for the elderly, with long-term care facility residents making up the largest portion of patients. A study from the National Institute on Deafness and Other Communication Disorders reported that 68% of residents in long-term care settings suffer from dysphagia.²

Left unchecked, dysphagia can cause a patient to aspirate (where food and/or liquid seeps into the airway during swallowing), leading to aspiration pneumonia. The mortality rate of aspiration pneumonia is around 21%,⁴ and this life-threatening condition constitutes between 5% and 15% of the 4.5 million cases of community-acquired pneumonia per year.

Due to these dangers, it is imperative that clinical professionals adopt best practices in the treatment of dysphagia, providing care that offers optimal quality of life but avoids reduced nutritional intake and complications that can lead to illness or death.

Traditional Management of Dysphagia

Bedside and radiographic testing are used to accurately diagnose dysphagia by determining a patient’s ability or inability to safely manage different consistencies of foods and liquids.⁵ If evidence of aspiration is found, clinicians generally suggest modifying the patient’s diet by softening solid foods and thickening fluids with a thickening agent that helps achieve a consistency of honey, pudding, or nectar.

But is thickening always the best practice for dysphagia treatment? There are conflicting schools of thought.

To Thicken…

Visual evidence from video fluoroscopy has shown that thickening liquids decreases the risk of aspiration, lowering the potential for aspiration pneumonia and its associated complications. However, thickened liquids can alter the quality of a patient’s life (such as tasting unpleasant or not quenching thirst, possibly leading to patients refusing them and becoming dehydrated) and may be best suited as part of a short-term strategy to tackle challenges associated with the acute phase of an illness or as an alternative to a feeding tube.⁵

 Thickened liquids also offer a reduced aspiration risk for patients unable to engage in other aspiration-prevention measures, such as beneficial intake postures, swallowing strategies, or swallowing exercises.

…Or Not to Thicken

While thickening liquids can be a valuable tool, particularly in certain short-term scenarios, other studies have found that giving dysphagia patients free water and unthickened liquids does not increase the overall rate of aspiration pneumonia.⁴ In fact, providing unthickened liquids can improve hydration and avoid the quality-of-life impacts associated with diets utilizing thickened liquids.

Coupled with other strategies like proper postural adjustments and swallowing exercises, avoiding artificially thickened liquids can reduce negative side effects such as dry mouth, dehydration, a feeling of fullness, and more.⁶ Free water, in particular, promotes a heightened quality of life.⁴

The Key Takeaway

Currently, there isn’t a consensus on the use of thickened liquids in caring for dysphagia patients. Studies and personal anecdotes suggest that this deeply personal decision should be made by the patient’s healthcare team together with the patient and caregivers. The particulars of an individual’s case should be considered to determine a plan of action that’s best suited to their unique needs.

Support for Those Caring for Dysphagia Patients

Since this issue likely won’t find a clear resolution any time soon, products for both strategies remain useful to clinicians and caregivers.

When used in conjunction with the Dysphagia Diet Protocol, DiaFoods Thick-It and Thick-It 2 help clinical professionals thicken any liquid or pureed food. It can be used on both hot and cold beverages and results in little to no odor and flavor changes.

For patients not receiving thickened liquids, dining aids like the Provale® Cup, which delivers small swallows that promote safer swallowing and increased independence, and the SafeStraw™, which features a small fluid chamber with a one-way valve and a float that regulates fluid draw, are available to assist dysphagia patients with control of thin liquids.

Learn more about AliMed’s full line of dysphagia products.

Resources:

1. https://swallowingdisorderfoundation.com/deciphering-dysphagia/
2. https://www.asha.org/Practice-Portal/Clinical-Topics/Adult-Dysphagia
3. https://www.asha.org/public/speech/swallowing/Swallowing-Disorders-in-Adults
4. https://www.journalofhospitalmedicine.com/jhospmed/article/194407/hospital-medicine/things-we-do-no-reason-use-thickened-liquids-treating
5. https://swallowstudy.com/decision-making-dysphagia-management
6. https://www.geripal.org/2015/01/do-thickened-liquids-help-people-with-dysphagia.html