The Geriatric Swallow: Through Thick and Thin
Publication: Perspectives of the ASHA Special Interest Groups
Volume 5, Number 4
Pages 1039-1044
Abstract
Purpose
The goal of this article was to assess the utility of thickened liquids for patients with oropharyngeal dysphagia.
Conclusion
The use of thickened liquids is pervasive, but clinical justification and understanding varies widely among practitioners of deglutition. The benefit of diet/liquid recommendations and other compensatory strategies should be validated via instrumental examination. As highlighted in this review, thickening of liquids may pose serious implications and consequences for both a patient's physical welfare and quality of life. Careful patient selection is recommended to ensure the expected benefits from liquid thickeners outweigh the risks.
Get full access to this article
View all available purchase options and get full access to this article.
References
Barbon, C. E. A., & Steele, C. M. (2019). Characterizing the flow of thickened barium and non-barium liquid recipes using the IDDSI flow test. Dysphagia, 34(1), 73–79.
Barczi, S. R., Sullivan, P. A., & Robbins, J. (2000). How should dysphagia care of older adults differ? Establishing optimal practice patterns. Seminar in Speech and Language, 21(4), 347–361.
Bhattacharyya, N., Kotz, T., & Shapiro, J. (2003). The effect of bolus consistency on dysphagia in unilateral vocal cord paralysis. Otolaryngology—Head & Neck Surgery, 129(6), 632–636.
Bock, J. M., Varadarajan, V., Brawley, M. C., & Blumin, J. H. (2017). Evaluation of the natural history of patients who aspirate. Laryngoscope, 127(Suppl. 8), S1–S10.
Bridget, P. (2014). Use of fluid thickener to reduce dysphagia risk. Nurs Times, 110(12), 16–18.
Castellanos, V. H., Butler, E., Gluch, L., & Burke, B. (2004). Use of thickened liquids in skilled nursing facilities. Journal of the Academy of Nutrition and Dietetics, 104(8), 1222–1226.
Cichero, J. A. (2013). Thickening agents used for dysphagia management: Effect on bioavailability of water, medication and feelings of satiety. Nutrition Journal, 12, 54.
Cichero, J. A., Lam, P., Steele, C. M., Hanson, B., Chen, J., Dantas, R. O., Duivestein, J., Kayashita, J., Lecko, C., Murray, J., Pillay, M., Riquelme, L., & Stanschus, S. (2017). Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: The IDDSI framework. Dysphagia, 32(2), 293–314.
Clave, P., de Kraa, M., Arreola, V., Girvent, M., Farre, R., Palomera, E., & Serra-Prat, M. (2006). The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Alimentary Pharmacology & Therapeutics, 24(9), 1385–1394.
Coyle, J. L., Davis, L. A., Easterling, C., Graner, D. E., Langmore, S., Leder, S. B., Lefton-Greif, M. A., LEslie, P., Logemann, J. A., Mackay, L., MArting-Harris, B., Murray, J. T., Sonies, B., & Steele, C. M. (2009). Oropharyngeal dysphagia assessment and treatment efficacy: Setting the record straight (response to Campbell-Taylor). Journal America Medical Directors Association Home, 10(1), 62–66, discussion 79–83.
Dantas, R. O., Cook, I. J., Dodds, W. J., Kern, M. K., Lang, I. M., & Brasseur, J. G. (1990). Biomechanics of cricopharyngeal bars. Gastroenterology, 99(5), 1269–1274.
DiBardino, D. M., & Wunderink, R. G. (2015). Aspiration pneumonia: A review of modern trends. Journal of Critical Care, 30(1), 40–48.
Ekberg, O., Hamdy, S., Woisard, V., Wuttge-Hannig, A., & Ortega, P. (2002). Social and psychological burden of dysphagia: Its impact on diagnosis and treatment. Dysphagia, 17(2), 139–146.
Feinberg, M. J., Knebl, J., Tully, J., & Segall, L. (1990). Aspiration and the elderly. Dysphagia, 5(2), 61–71.
Finestone, H. M., Foley, N. C., Woodbury, M. G., & Greene-Finestone, L. (2001). Quantifying fluid intake in dysphagic stroke patients: A preliminary comparison of oral and nonoral strategies. Archives of Physical Medicine Rehabilitation, 82(12), 1744–1746.
Fox, K. A., Mularski, R. A., Sarfati, M. R., Brooks, M. E., Warneke, J. A., Hunter, G. C., & Rappaport, W. D. (1995). Aspiration pneumonia following surgically placed feeding tubes. The America Journal of Surgery, 170(6), 564–566, discussion 566–567.
Garcia, J. M., Chambers, E. t., Matta, Z., & Clark, M. (2008). Serving temperature viscosity measurements of nectar- and honey-thick liquids. Dysphagia, 23(1), 65–75.
Garcia, J. M., Chambers, E. T., & Molander, M. (2005). Thickened liquids: Practice patterns of speech-language pathologists. American Journal of Speech-Language Pathology, 14(1), 4–13.
Glassburn, D. L., & Deem, J. F. (1998). Thickener viscosity in dysphagia management: Variability among speech-language pathologists. Dysphagia, 13(4), 218–222.
Goulding, R., & Bakheit, A. M. (2000). Evaluation of the benefits of monitoring fluid thickness in the dietary management of dysphagic stroke patients. Clinical Rehabilitation, 14(2), 119–124.
Hanson, B., O'Leary, M. T., & Smith, C. H. (2012). The effect of saliva on the viscosity of thickened drinks. Dysphagia, 27(1), 10–19.
Hutcheson, K. A., Barrow, M. P., Barringer, D. A., Knott, J. K., Lin, H. Y., Weber, R. S., Fuller, C. D., Lai, S. Y., Alvarez, C. P., Raut, J., Roe, J. W., Starmer, H. M., & Lewin, J. S. (2017). Dynamic Imaging Grade of Swallowing Toxicity (DIGEST): Scale development and validation. Cancer, 123(1), 62–70.
Inamoto, Y., Saitoh, E., Okada, S., Kagaya, H., Shibata, S., Ota, K., Baba, M., Fujii, N., Katada, K., Wattanapan, P., & Palmer, J. B. (2013). The effect of bolus viscosity on laryngeal closure in swallowing: Kinematic analysis using 320-row area detector CT. Dysphagia, 28(1), 33–42.
Kuhlemeier, K. V., Palmer, J. B., & Rosenberg, D. (2001). Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia, 16(2), 119–122.
LaCroix, A. Z., Lipson, S., Miles, T. P., & White, L. (1989). Prospective study of pneumonia hospitalizations and mortality of U.S. older people: The role of chronic conditions, health behaviors, and nutritional status. Public Health Reports, 104(4), 350–360.
Langmore, S. E., Terpenning, M. S., Schork, A., Chen, Y., Murray, J. T., Lopatin, D., & Loesche, W. J. (1998). Predictors of aspiration pneumonia: How important is dysphagia? Dysphagia, 13(2), 69–81.
Lee, S. I., Yoo, J. Y., Kim, M., & Ryu, J. S. (2013). Changes of timing variables in swallowing of boluses with different viscosities in patients with dysphagia. Archives of Physical Medicine and Rehabilitation, 94(1), 120–126.
Leibovitz, A., Baumoehl, Y., Lubart, E., Yaina, A., Platinovitz, N., & Segal, R. (2007). Dehydration among long-term care elderly patients with oropharyngeal dysphagia. Gerontology, 53(4), 179–183.
Leonard, R. J., White, C., McKenzie, S., & Belafsky, P. C. (2014). Effects of bolus rheology on aspiration in patients with Dysphagia. Journal of the Academy Nutrition and Dietetics, 114(4), 590–594.
Lindgren, S., & Janzon, L. (1991). Prevalence of swallowing complaints and clinical findings among 50-79-year-old men and women in an urban population. Dysphagia, 6(4), 187–192.
Liu, C., Cao, Y., Lin, J., Ng, L., Needleman, I., Walsh, T., & Li, C. (2018). Oral care measures for preventing nursing home-acquired pneumonia. Cochrane Database Systematic Reviews, 9. Cd012416.
Logemann, J. A. (1998). Evaluation and treatment of swallowing disorders (2nd ed.). Pro-Ed.
Logemann, J. A., Gensler, G., Robbins, J., Lindblad, A. S., Brandt, D., Hind, J. A., Kosek, S., Dikeman, K., KAzandjian, M., Gramigna, G. D., Lundy, D., McGarvey Toler, S., & Miller Gardner, P. J. (2008). A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson's disease. Journal of Speech, Language and Hearing Research, 51(1), 173–183.
Manrique, Y. J., Sparkes, A. M., Cichero, J. A., Stokes, J. R., Nissen, L. M., & Steadman, K. J. (2016). Oral medication delivery in impaired swallowing: Thickening liquid medications for safe swallowing alters dissolution characteristics. Drug Development and Industrial Pharmacy, 42(9), 1537–1544.
Marik, P. E. (2001). Aspiration pneumonitis and aspiration pneumonia. New England Journal of Medicine, 344(9), 665–671.
McCurtin, A., Healy, C., Kelly, L., Murphy, F., Ryan, J., & Walsh, J. (2018). Plugging the patient evidence gap: What patients with swallowing disorders post-stroke say about thickened liquids. International Journal of Language & Communication Disorders, 53(1), 30–39.
Murray, J., Miller, M., Doeltgen, S., & Scholten, I. (2014). Intake of thickened liquids by hospitalized adults with dysphagia after stroke. International Journal of Speech-Language Pathology, 16(5), 486–494.
Nativ-Zeltzer, N., Kuhn, M. A., Imai, D. M., Traslavina, R. P., Domer, A. S., Litts, J. K., Adams, B., & Belafsky, P. C. (2017). The effects of aspirated thickened water on survival and pulmonary injury in a rabbit model. The Laryngoscope, 128(2).
O'Keeffe, S. T. (2018). Use of modified diets to prevent aspiration in oropharyngeal dysphagia: Is current practice justified? BMC Geriatrics, 18(1), 167.
Parojcic, J., Vasiljevic, D., Ibric, S., & Djuric, Z. (2008). Tablet disintegration and drug dissolution in viscous media: Paracetamol IR tablets. International Journal Pharmaceutics, 355(1–2), 93–99.
Robbins, J., Gensler, G., Hind, J., Logemann, J. A., Lindblad, A. S., Brandt, D., Baum, H., Lilienfeld, D., Kosek, S., Lundy, D., Dikeman, K., Kazandjian, M., Gramigna, G. D., McGarvey-Toler, S., & Miller Gardner, P. J. (2008). Comparison of 2 interventions for liquid aspiration on pneumonia incidence: A randomized trial. Annals Internal Medicine, 148(7), 509–518.
Rofes, L., Arreola, V., Mukherjee, R., Swanson, J., & Clave, P. (2014). The effects of a xanthan gum-based thickener on the swallowing function of patients with dysphagia. Aliment Pharmacology & Therapeutics, 39(10), 1169–1179.
Seedat, J., & Penn, C. (2016). Implementing oral care to reduce aspiration pneumonia amongst patients with dysphagia in a South African setting. South African Journal of Communication Disorders, 63(1).
Serra-Prat, M., Hinojosa, G., Lopez, D., Juan, M., Fabre, E., Voss, D. S., Calvo, M., Marta, V., Ribo, L., Palomera, E., Arreola, V., & Clave, P. (2011). Prevalence of oropharyngeal dysphagia and impaired safety and efficacy of swallow in independently living older persons. Journal of the American Geriatrics Society, 59(1), 186–187.
Sharpe, K., Ward, L., Cichero, J., Sopade, P., & Halley, P. (2007). Thickened fluids and water absorption in rats and humans. Dysphagia, 22(3), 193–203.
Shim, J. S., Oh, B. M., & Han, T. R. (2013). Factors associated with compliance with viscosity-modified diet among dysphagic patients. Annals Rehabilitation Medicine, 37(5), 628–632.
Son, Y. G., Shin, J., & Ryu, H. G. (2017). Pneumonitis and pneumonia after aspiration. Journal Dental Anesthesia Pain Medicine, 17(1), 1–12.
Spain, D. A., DeWeese, R. C., Reynolds, M. A., & Richardson, J. D. (1995). Transpyloric passage of feeding tubes in patients with head injuries does not decrease complications. Journal Trauma and Acute Care Surgery, 39(6), 1100–1102.
Speyer, R., Baijens, L., Heijnen, M., & Zwijnenberg, I. (2010). Effects of therapy in oropharyngeal dysphagia by speech and language therapists: A systematic review. Dysphagia, 25(1), 40–65.
Steele, C. M., Alsanei, W. A., Ayanikalath, S., Barbon, C. E., Chen, J., Cichero, J. A., Coutts, K., Dantas, R. O., Duivestein, J., Giosa, L., Hanso, B., Lam, P., Lecko, C., Leigh, C., Nagy, A., Namasivayam, A. M., Nascimento, W. N., Odendaal, I., Smith, C. H., & Wang, H. (2015). The influence of food texture and liquid consistency modification on swallowing physiology and function: A systematic review. Dysphagia, 30(1), 2–26.
Steele, C. M., Molfenter, S. M., Peladeau-Pigeon, M., Polacco, R. C., & Yee, C. (2014). Variations in tongue-palate swallowing pressures when swallowing xanthan gum-thickened liquids. Dysphagia, 29(6), 678–684.
Sukkar, S. G., Maggi, N., Travalca Cupillo, B., & Ruggiero, C. (2018). Optimizing texture modified foods for oro-pharyngeal dysphagia: A difficult but possible target? Frontiers in Nutrition, 5, 68.
Taniguchi, H., Tsukada, T., Ootaki, S., Yamada, Y., & Inoue, M. (2008). Correspondence between food consistency and suprahyoid muscle activity, tongue pressure, and bolus transit times during the oropharyngeal phase of swallowing. Journal Applied Physiology, 105(3), 791–799.
Vilardell, N., Rofes, L., Arreola, V., Speyer, R., & Clave, P. (2016). A comparative study between modified starch and xanthan gum thickeners in post-stroke oropharyngeal dysphagia. Dysphagia, 31(2), 169–179.
Whelan, K. (2001). Inadequate fluid intakes in dysphagic acute stroke. Clinical Nutrition, 20(5), 423–428.
Wirth, R., Dziewas, R., Beck, A. M., Clavé, P., Hamdy, S., Heppner, H. J., Leischer, L., Pluschinski, M. R., Warnecke, S., & Volkert, D. (2016). Oropharyngeal dysphagia in older persons – from pathophysiology to adequate intervention: A review and summary of an international expert meeting. Clinical Interventions in Aging, 11, 189–208.
Information & Authors
Information
Published In
Copyright
Copyright © 2020 American Speech-Language-Hearing Association.
History
- Received: Oct 9, 2019
- Revised: Feb 28, 2020
- Accepted: May 7, 2020
- Published online: Jul 10, 2020
- Published in issue: Aug 17, 2020
Authors
Metrics & Citations
Metrics
Article Metrics
View all metricsCitations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
