[Dysphagia] VFSS

[rd4u at sympatico.ca (Brad Harvey)]

I have a question about the interpretation of VFSS.  One of my residents 
recently had one done that showed residuals on the valleculae with cookie, 
fruit cocktail, thin fluids and thick fluids.  Aspiration occurred 2 out of 
3 attempts with thin fluids, none with thick fluids and 1 out of 2 attempts 
with fruit cocktail and it was suspect it was the thin fluid component.  The 
cookie left residuals, but no observed entry into the airway.  No cough was 
observed with the aspirations.

The recommendation was for minced texture with honey thick fluids.  The 
resident is refusing to eat minced texture and thick fluids.  We have 
recently changed to already prepared thick fluids and she has agreed to try 
these only after I explained the results of her VFSS and the likelihood of 
aspiration and risk of pneumonia.  She is adament that she receive regular 
texture which I have reluctantly agreed to.  She is her own POA and she is 
91yo and feels it is a quality of life thing. I have the staff tracking any 
difficulties and discussed appropriate interventions.

Is a digestive cookie not considered minced texture?  With residuals being 
left with even thick fluids is there any increased risk providing regular as 
I would think that pureed would be fairly comparable to thick fluids?

Your help is much appreciated,
Brad Harvey, RD