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Dysphagia: To Thicken or not to Thicken

Thickened fluids play a key role in the management of swallowing difficulties, clinically known as dysphagia, but are they the best solution? While there are clear benefits of thickened liquids for someone with dysphagia, there are also several disadvantages that should be considered. This article will explore the evidence surrounding the pros and cons of thickened fluids and the implications it has for those living with dysphagia. Thicker is not always safer.

What are thickened fluids?

Thickened fluids are fluids that are of a thicker consistency than thin fluids. Thin fluids are fluids with the same consistency as water. There are thickening products available, such as powders and liquids, that can thicken thin fluids when added to them. These products use starches and gums as the thickener, and typically have little to no taste. Additionally, there are fluids that are naturally thick: such as fruit nectar juices and milkshakes.

Dysphagia management and IDDSI To Thicken or not to Thicken fluids

Who needs Thickened Fluids?

Thickened fluids are often recommended for those who have dysphagia. Drinking thickened fluids can assist in preventing fluid entering the airway and lungs, also known as aspiration. Thickened fluids move slower than thin fluids, therefore allowing your body more time to move the muscles in your throat and close and protect your airway as the fluid moves down into your oesophagus. It also allows greater control of the fluid in the mouth, to avoid it pre-maturely going into your airway or oesophagus. Thin fluids require more coordination and strength to swallow than thickened fluids…I’m sure we’ve all had our water go down the wrong pipe before.

What are the signs of aspiration?

When there is food or fluid entering the airway, there are a few things that occur when someone is eating or drinking. These include coughing, choking, wet-voice quality, gurgly sound in the chest, feeling congested after eating or drinking and breathing changes. Aspiration can also occur even when these signs are not present. This is called silent aspiration. Some signs of silent aspiration to be conscious of are long-term weight-loss, reoccurring chest infections (aspiration pneumonia), repeated low-grade fevers and noisy breathing.

What’s so good about thickened fluids?

There are numerous benefits of consuming thickened liquids for someone with dysphagia. Some of these include:

  • Reduced risk of aspiration and aspiration pneumonia. Aspiration pneumonia is an infection caused by bacteria from saliva, food or fluid travelling into the lungs.

  • Increased hydration.

  • Improved timing, control and sensation involved when swallowing fluids.

  • Improved swallow safety and airway protection.

  • Reduced hospitalisation risk.

  • Reduced anxiety and embarrassment during fluid intake.

  • Improved quality of life.

What could go wrong with thickened fluids?

While there are many advantages of thickened fluids, we also need to consider the cons. Some examples of this include:

  • Change in texture can be unappealing to consume.

  • Dehydration due to reduced fluid intake from texture being unappealing.

  • Time needed for preparation.

  • Increased risk of silent aspiration.

  • Non-compliance with recommended thickened fluid.

  • Increased fatigue when drinking.

  • Increased feeling of fullness when drinking.

  • Can affect the way your body processes medication. Thicker fluids can affect the breakdown of certain medications and cause the release of the medication to slow down.

  • Trying to thicken some commercial supplements. Resource Fruit and Arginaid Extra (tetra pack) cannot be thickened safely and should not be provided to anyone requiring thickened fluids. An alternative supplement that can be safely thickened to the correct consistency should be sourced. Involved a Speech Pathologist and Dietitian in this process.

IDDSI Texture modified Foods and fluids Training

So, to thicken or not to thicken?

Thickened fluids can be a valuable tool, and arguably essential for some people with dysphagia to improve the safety of their swallow. However, it is not a ‘thick-fix’ and it is not the only solution for dysphagia. There are many things that need to be considered before thickened fluids can be recommended. It is essential to have a discussion with the patient and their family and/or carers about if they wish to consume thickened liquids, and the pros and cons of consuming them. Picture this…someone has been given thickened fluids, but the taste and texture is off-putting to them, and they refuse to drink fluids. Isn’t the risk of dehydration much greater than the risk of aspiration?  

In saying this, it is critical to involve a Speech Pathologist and GP where someone chooses not to have thickened fluids, despite the recommendation they have been given. All advantages and disadvantages of thickened fluids must be considered by the Speech Pathologist, patient, and their carer’s and/or family before any recommendations are provided or altered.

How to prevent aspiration chocking on water with dysphagia

What can someone with dysphagia do to prevent aspiration?

There are many safe swallowing strategies that someone with dysphagia can follow to reduce their risk of aspiration, aside from thickening fluids.

These include:

  • Sitting upright at 90 degrees (or as close to as possible) for all oral intake.

  • Being alert and awake for all oral intake.

  • Taking smaller sips of fluid and/or mouthfuls of food.

  • Minimise distractions while eating and drinking. For example, turning the TV off or minimising talking during mealtimes.

  • Taking frequent breaks during mealtimes if you find it fatiguing.

  • Taking medications one at a time if taking them whole.

  • Perform good oral hygiene, ensuring to brush your teeth/dentures and floss daily.

  • Ensuring your mouth is free of food and fluid when you are finished eating.

Managing Dysphagia with a Speech Pathologist

To manage your dysphagia safely, it is important to work with a Speech Pathologist (like us!) Our team of Speech Pathologists work in Aged Care and are available through our clinic for telehealth, home visits or face-to-face in Mulgrave, Victoria. We’re here to help keep your residents safe.

Our team of Speech Pathologists conduct IDDSI training for texture modified foods for family members and carers, and for staff within Aged Care. See upcoming dates.


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