Many of us are able to maintain proper nutrition and hydration by eating enough fruits and vegetables and remembering to drink water. But for the 590 million people worldwide living with dysphagia[i], achieving adequate calorie, nutrient and fluid intake can be more challenging.
Because dysphagia can have a profound effect on a person’s ability to bite, chew, and swallow food, it can lead to malnutrition. According to one study published in Clinical Nutrition, 37.8% of subjects with dysphagia were malnourished, and 46.2% were at risk of malnourishment.[ii] Fluid intake is also restricted in many dysphagia patients, putting them at an increased risk for dehydration. In fact, among those suffering from swallowing difficulties, the prevalence of dehydration ranges from 44 to 75%.[iii]
Dysphagia can lead to malnutrition and dehydration for a variety of reasons. First, many patients require their foods and liquids to be thickened prior to consumption. While these thickened foods and liquids are usually safer and easier to swallow, some have lower energy densities, meaning that patients on texture modified diets may need more frequent, energy-dense meals and snacks.[iv] Thickening foods and liquids can also alter their appearance, texture, taste and temperature, which can affect a patient’s appetite.
Additionally, the loss of independence during mealtimes can contribute to reduced food and liquid intake, as eating may be slower, use of cutlery may be limited, and patients may feel embarrassment dining in front of others. Some even experience a fear of choking that can make them (and their caregivers) nervous about mealtimes.
Fortunately, there are many ways healthcare professionals can ensure patients with dysphagia are staying hydrated and their nutritional needs are being met. This includes knowing which products are right for an individual patient and how they should be consumed.
- Getting dysphagia patients to comply with their recommended modified diets can be a challenge; however, speech-language pathologists, dietitians and healthcare professionals can work together to create a meal plan that is safe and nutritious while also aesthetically pleasing and appetizing. Because meals that look and taste natural can increase consumption, the team of swallowing specialists can work with patients to design the most permissive yet safe modified dysphagia diet of soft, minced or moist, puréed or liquefied food.
- For those with dysphagia, consuming foods and liquids can be tiring. Long-term care professionals should be flexible in the timing of meals and snacks by serving them when patients are most alert and attentive. Some might also be encouraged to eat and drink if they are provided with smaller dishes throughout the day, which can be less daunting than three large meals.
- Fortunately, staying hydrated doesn’t mean just drinking water. Serving foods with a high liquid content such as soups, purées, or freezer pops is also an effective way to deter dehydration.
- Where possible, ask patients about their beverage preferences. A variety of products, such as Thick-It® Clear Advantage® Ready-to-Drink Beverages, which come in water, coffee, tea, and juice varieties, are available to support hydration and satisfy patient choice. For additional customization, thickeners can be added to a desired flavored drink, allowing patients and caregivers to modify flavors to their choosing.
- Optimize food and liquid intake by practicing safe feeding and swallowing techniques. Make sure the patient is sitting in an upright position while eating and drinking by providing a sturdy chair that allows them to sit comfortably with their feet on the floor. Alternate between small bites and sips, encouraging the patient to eat slowly to prevent aspiration. Before feeding the next bite, ensure all foods and liquids are swallowed and that there is no accumulation of food in the cavities of the cheek or on the tongue.
- When appropriate, restore independence by providing products that allow patients to dine and drink with dignity. For example, Thick-It® Clear Advantage® Ready-to-Drink Beverages—which come in 8 fluid ounce resealable bottles and are made with xanthan gum — are easy to use, maintain a stable viscosity over time, and remain consistent across a range of temperatures. This gives patients more flexibility and time to safely consume them.
Although dysphagia can present a variety of complications, employing these strategies can help promote a safe and healthy life for patients while also ensuring proper nutrition and hydration.
Susan Norris is a regional sales manager for the Personal Nutrition Solutions (PNS) division of Kent Precision Foods Group Inc., which produces the Thick-It® brand family of products.
[i] International Dysphagia Diet Standardisation Initiative, https://iddsi.org/
[ii] Lauretani, Maggio, Meschi, Pela, Tagliaferri, “The risk of dysphagia is associated with malnutrition and poor functional outcomes in a large population of outpatient older individuals.” Clinical Nutrition. 2018.
[iii] Dähn, Gomes, Reber, Stanga, Vasiloglou, “Management of Dehydration in Patients Suffering Swallowing Difficulties. Journal of Clinical Medicine,” Journal of Clinical Medicine, Nov. 2019.
[iv] Crawley, Helen, “Malnutrition and eating difficulties.” Nursing Times, Jan. 2009.
