Madeleine Hull
A patient may be on a thickened liquid diet due to difficulties with swallowing, a condition known as dysphagia. Liquids are thickened with starches or gums to slow their flow, allowing the patient more time to swallow safely and prevent choking. While thickened liquids are often used to manage dysphagia, they are not well-liked by patients and can have unintended consequences such as dehydration and impaired medication absorption. Clinicians are therefore encouraged to prescribe the minimum level of thickness required for safe swallowing.
| Characteristics | Values |
|---|---|
| Purpose | To help patients with eating, drinking, and swallowing difficulties (EDS) or dysphagia, preventing choking and fluid from entering the lungs. |
| Mechanism of Action | Thickened liquids flow more slowly than thin liquids, giving patients more time to swallow safely and protect their airways. |
| Patient Preference | Patients often dislike the taste and mouthfeel of thickeners, which can suppress the flavor of the actual liquid and increase feelings of satiety. Offering different options and working with patients to find the most palatable combination is important for adherence. |
| Dehydration Risk | Thickened liquids can contribute to dehydration, especially if patients are already dehydrated due to their condition or setting. Clinicians should prescribe the minimal thickness needed and implement strategies to improve hydration, such as offering liquids more frequently. |
| Medication Impact | Viscous substances can impair the bioavailability of medication, slowing drug release. Consultation with pharmacy and dietetic staff is essential for optimum management. |
| Consistency | The International Dysphagia Diet Standardisation Initiative (IDDSI) has developed a scale to describe liquid thickness, ranging from thin liquids to nectar-thick and honey-thick consistencies. |
| Availability | Thickening powders and pre-thickened beverages can be purchased from local pharmacies or directly from manufacturers. Examples include Thick-It, Thick n' Easy, Simply Thick, and more. |
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What You'll Learn
- To aid patients with eating, drinking and swallowing difficulties
- To prevent choking and stop fluid from entering the lungs
- To help manage dysphagia, or difficulty swallowing
- To prevent aspiration, or the entry of food or fluid into the airways
- To reduce the risk of pneumonia, which is common in people with swallowing difficulties
To aid patients with eating, drinking and swallowing difficulties
Dysphagia is a medical term for difficulty swallowing. Thickened liquids are often used to aid patients with eating, drinking and swallowing difficulties, also known as dysphagia. Liquids that are naturally thin, such as water, coffee, milk, soda, broth, and carbonated drinks, can be difficult for people with dysphagia to swallow. This is because the fast flow of liquids can be difficult to control during passage through the pharynx, resulting in impaired airway protection.
Thickened liquids are used to improve bolus control and help prevent aspiration. They move more slowly than thin liquids, giving the patient's body more time to protect the airway and coordinate safe swallowing. This prevents choking and stops fluid from entering the lungs. Liquids can be thickened with powders or gels, and there are different levels of thickness, from nectar-like to honey-like and spoon- or pudding-thick. The least viscous liquid is usually used for mild dysphagia, while thicker liquids are used for more severe forms of the condition. The thickness of liquids can be tested using a flow test.
There are potential disadvantages to thickened liquids. They are not usually enjoyed by patients, as they do not taste or feel good in the mouth. They can also increase feelings of satiety and thirst, and impair the bioavailability of medication. Clinicians are therefore encouraged to prescribe the minimal level of thickness needed for swallowing safety. It is also important to address the issue of hydration, as thickened liquids can contribute to dehydration.
A multidisciplinary and multifactorial approach is beneficial for people with eating, drinking and swallowing difficulties. Speech language pathologists can recommend thickened liquids and advise on the appropriate thickness level. They can also provide information on different thickening agents, such as starches and gums, and the different flavours that can be used to improve palatability.
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To prevent choking and stop fluid from entering the lungs
People who have difficulty swallowing thin liquids are often recommended to drink thickened liquids. This is because thickened liquids move slower than thin liquids, giving the body more time to protect the airway, thereby preventing choking and stopping fluid from entering the lungs. This condition is known as dysphagia—the medical term for difficulty swallowing.
Thickened liquids are often used in the management of dysphagia to improve bolus control and to help prevent aspiration. Liquids that are naturally thick include fruit nectars, milkshakes, eggnog, tomato juice, and cream-based soups. Other liquids can be made thick with powders or gels. Examples of thin liquids are water, coffee, milk, soda, broth, carbonated drinks, and ice cream.
The International Dysphagia Diet Standardisation Initiative (IDDSI) has created a scale for describing the thickness of liquids. The different thickness levels are:
- Level 1: A little thicker than water. Can be sucked through a standard straw easily.
- Level 2: Can be sipped from a cup. Can be sucked through a standard straw with some effort. Used to be called nectar-thick liquids.
- Level 3: Can be sucked through a wide straw with some effort. Take a little more time to swallow. Your tongue will need to hold the liquid in your mouth before you swallow it. Used to be called honey-thick liquids.
It is important to note that thickened liquids are not a patient's first choice, but rather a necessity for safety. They are also not very palatable, and patients may not adhere to them. Therefore, it is recommended to offer different flavours and textures to patients to help them find the most acceptable combination.
Additionally, a plan for hydration is crucial when recommending thickened liquids, as they can contribute to dehydration.
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To help manage dysphagia, or difficulty swallowing
Dysphagia is a medical term for difficulty swallowing. People with this condition find it difficult to control the turbulent and fast flow of liquids during passage through the pharynx, resulting in impaired airway protection. Thickened liquids are often used in the management of dysphagia to improve bolus control and help prevent aspiration. Liquids that are naturally thick, or liquids thickened with powders or gels, move more slowly than thin liquids, giving the body more time to protect the airway and coordinate safe swallowing. This can help prevent choking and stop fluid from entering the lungs.
Thickened liquids are not a patient's dietary choice, but a necessity for their safety. They have been used therapeutically to manage dysphagia for about 19 years. There are at least three levels of viscosity used for the management of dysphagia: the least viscous liquid (akin to the thickness of nectar) is used for mild dysphagia, while thicker liquids are used for more severe forms of the condition. The prescription of fluid thickness is patient-specific, and a speech-language pathologist will recommend how thick a patient's liquids should be.
There are several disadvantages to thickened liquids. They are generally unpopular with patients, who find them unpalatable and difficult to accept. They also have the potential to impair the bioavailability of medication and increase feelings of thirst and satiety. Clinicians are therefore encouraged to prescribe the minimal level of thickness needed for swallowing safety. Consultation with pharmacy and dietetic staff is essential for optimum management of individuals with dysphagia.
There is a high likelihood of variability in the practice of using thickened liquids, due to the lack of clear definitions for different degrees of thickening. For example, liquids used in dysphagia management in North America have been known by the labels thin, nectar-like, honey-like, and spoon- or pudding-thick since the publication of the National Dysphagia Diet (NDD) in 2002. However, the equipment and skills necessary to perform accurate viscosity measurements at controlled shear rates are not accessible to clinicians, caregivers, or patients with dysphagia. This has resulted in choking deaths due to the provision of inappropriate food textures to patients with dysphagia.
To address this issue, the International Dysphagia Diet Standardisation Initiative (IDDSI) created a scale for describing the thickness of liquids. However, individuals who are involved in purchasing or preparing thickened liquids for people with dysphagia often rely on subjective measures, such as stirring and manipulation of a liquid, observation of the liquid while being poured, or analysis of the liquid by mouthfeel. This can lead to poor quality control of liquid consistency and inappropriate thicknesses of liquid being provided to patients.
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To prevent aspiration, or the entry of food or fluid into the airways
Dysphagia, or difficulty swallowing, is a condition that can cause impaired airway protection. Liquids tend to flow turbulently and quickly through the pharynx, making it difficult for individuals with dysphagia to coordinate safe swallowing. This can lead to aspiration, where food or liquid enters the airways, causing choking and potentially allowing fluid to enter the lungs.
To prevent aspiration, patients with dysphagia are often placed on a thickened liquid diet. Thickened liquids move more slowly than thin liquids, giving the patient's body more time to protect the airway and coordinate swallowing. This is achieved by adding thickeners, such as starches or gums, to liquids. The amount of thickener added can vary depending on the desired consistency, with more severe cases of dysphagia requiring thicker liquids. For example, liquids thickened to a nectar-like consistency are often used for mild dysphagia, while thicker consistencies, such as honey-like or spoon-thick, may be prescribed for more severe cases.
The International Dysphagia Diet Standardisation Initiative (IDDSI) has developed a scale to describe the thickness of liquids, providing guidance on how thick liquids should be for different levels of dysphagia. Speech language pathologists work with patients to determine the appropriate thickness level and provide recommendations on how to achieve the desired consistency.
While thickened liquids can improve swallow safety, they may have unintended consequences, such as increased feelings of satiety and thirst, which can lead to dehydration. Additionally, the unusual mouthfeel and bitter taste of thickened liquids can affect patient adherence to the diet. It is important for healthcare professionals to work with patients to find palatable combinations of thickeners and liquids and to address hydration concerns.
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To reduce the risk of pneumonia, which is common in people with swallowing difficulties
People with eating, drinking, and swallowing difficulties (EDS) may be placed on a thickened liquid diet to reduce the risk of pneumonia, which is common in this group. This phenomenon is known as 'aspiration pneumonia'.
Dysphagia is the medical term for difficulty swallowing. Liquids that are naturally thin, such as water, coffee, milk, and soda, can be difficult for people with dysphagia to control during their passage through the pharynx, resulting in impaired airway protection. Thickened liquids, on the other hand, flow more slowly, giving the individual more time to coordinate safe swallowing. This reduces the risk of aspiration, which is when food or fluid enters the airways below the true vocal folds.
However, the use of thickened liquids for people with EDS is controversial. While they can improve swallow safety, they are not well-liked by patients, who find them unpleasant and difficult to adhere to. There is also a risk of dehydration, as well as impaired medication absorption, due to the physical property of viscosity. Clinicians are therefore encouraged to prescribe the minimal level of thickness needed for swallowing safety and to work with dietetic colleagues to trial a range of non-thickened liquid solutions.
Furthermore, there is a lack of standardisation in the terminology and guidelines surrounding thickened liquids, leading to potential confusion and patient safety risks. For example, the labels 'thin', 'nectar-like', 'honey-like', and 'spoon-thick' are used to describe different levels of viscosity, but there is no accessible method for clinicians, caregivers, or patients to accurately measure viscosity. This can lead to inconsistencies in the thickness of liquids provided to patients, which may have serious consequences.
Overall, while thickened liquids can be a useful tool for managing swallowing difficulties and reducing the risk of pneumonia, it is important to consider the potential drawbacks and risks associated with their use. A multidisciplinary and multifactorial approach is beneficial, and patient preferences should be taken into account when designing a treatment plan.
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Frequently asked questions
A patient may be on a thickened liquid diet due to difficulties with swallowing, known as dysphagia. Thickened liquids help to improve bolus control and prevent aspiration, which is when food or fluid enters the lungs.
Thickened liquids are liquids that have been made thicker by adding a thickening agent, such as a powder or gel. Some liquids are naturally thick, while others can be purchased pre-thickened. The level of thickness required depends on the severity of the patient's condition.
Thickened liquids can be unpalatable, leading to poor adherence to the diet. They may also contribute to dehydration and affect the bioavailability of medication. Clinicians should, therefore, prescribe the minimal level of thickness required to aid swallowing.
