[Dysphagia] re: hydration with thickened liquids

[pressmah at sjhmc.org (Pressman, Hilda)]

Thank you Mary for a comprehensive response.  I have begun to advise my adult patients the way I advised my pediatric patients.  That is to add applesauce to water or juice and to add milk to yogurt.  Make a smoothie.  There are lots of recipes out there.  These are more acceptable.  When the patient is in the hospital or in rehab or a nursing home this is, of course, difficult.  Perhaps we can get the dieticians involved in creating more palatable thick liquids.

Hilda Pressman MA, CCc SLP BRS-S

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
Behalf Of Casper219@aol.com
Sent: Saturday, February 04, 2006 11:07 AM
To: dysphagia@b9.com
Subject: [Dysphagia] re: hydration with thickened liquids


Thickening the liquids themselves does not significantly reduce the 
availability of fluids.  Based on the chemical composition of the item (i.e., milk has 
higher protein than apple juice so binds differently to the starch) thickened 
liquids usually have 95%+ fluid availability.  

The hydration risks faced by our patients who are truly more comfortable 
using thickened liquids (please don't blast me - I'm not suggesting that thickened 
liquids are a great intervention and I very much understand the risks 
involved) ... the hydration risks faced by our patients using thickened liquids come 
mostly from ACCEPTANCE.  

Encouraging liquid acceptance can be multifaceted.  First, the patient and 
caregivers have to realize that the perception of the liquid is altered by 
thickening it.  If you were told "this is your coffee" you have a certain mouth 
feel and taste in mind.  If you try a drink of thickened coffee, it is not the 
same, therefore the mind feels cheated.  Recognizing that, it is important to 
work with the patient on accepting the different perception as good or OK.  
Second, because the perception / expectation is altered when using thickened 
liquids, caregivers (or patients themselves) may tend to reserve the liquids until 
the end of the meal - because the caregiver thinks it will taste bad to the 
patient or the patient themself anticipates they will dislike it.  Encouraging p
atients and caregivers to consume / offer liquids before and throughout the 
meal will help to overcome this issue.  Third, this is more about perception, do 
we really provide thickened liquids at the temperature that we would normally 
hold our other liquids.  Some people prefer ice in their drinks, and we tend 
not to put ice in thickened liquids.  Chilling or heating the beverages to the 
preferred temperature can make a world of difference in the perception.  
Finally, perception of thirst quenching is an issue with thickened liquids.  They 
just don't seem to be as refreshing for most people.  Modifying temperature as 
suggested previously might help with that perception.  Or offering liquids 
more frequently might reduce the occurence of the sensation of thirst in the 
first place.

Practically speaking, I try to make sure my patients on thickened liquids 
have excellent and frequent oral care, so if they do aspirate food / liquid, the 
likelihood they will develop complications from aspiration might be reduced. 

Hope that these insights were helpful.  We need to look at the whole picture 
of our patients and determine the best intervention for them based on more 
than just observation of aspiration.  

Mary Casper, MA, CCC-SLP, BRS-S
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