Blog
Diet Modification for Individuals with Dysphagia
By: Cara Kennedy
Dysphagia
- Swallowing disorder, “disturbance of bolus flow”
- “Problems involving the oral cavity, pharynx, esophagus, or gastroesophageal junction,” (ASHA, n.d.)
- More common in adults
- Various causes – – – treatment in dependent on the cause
- Main goals: decrease aspiration risk, ensure adequate nutrition/hydration, possibly strengthen muscles or improve coordination for swallowing, decrease anxiety surrounding eating/drinking
- If not treated: can cause malnutrition, dehydration, aspiration pneumonia, or death
- Of patients who aspirate, approximately 38% develop aspiration pneumonia
Diet Modification– International Dysphagia Diet Standardization Initiative (IDDSI)
- Created in 2013
- “Providing a common terminology for describing food textures and drink thicknesses to improve safety for individuals with swallowing difficulties,” (IDDSI, 2019)
- 8 levels (0-7) to describe food textures and drink thicknesses
Advantages of Thickening Liquids
- “Reduces aspiration risk & helps prevent common complications” (dehydration, PNA, etc)
- Can reduce fear/anxiety associated with choking
- Thicker viscosity liquids are slower in movement
- Quicker movement can “increase risk of airway invasion” especially for individuals with poor manipulation of the bolus, poor airway closure, etc.
- Allows more time for airway closure
- More cohesive (thin liquids have the capacity to stretch)
- “May be helpful in cases where thin liquids are refluxed into the nasal cavity” with an otherwise adequate swallow mechanism
Disadvantages to Thickening Liquids
- Using thickeners: not everyone will know how to use them effectively
- “Thickening agents may cause side effects such as constipation, gassiness, or loose stools’” (Intermountain Healthcare, 2020)
- Thicker viscosities- can be harder to manipulate orally and propel
- May increase oral or pharyngeal residue
- Can aspirate residue from overflow
- We do not know what happens to reside if it is not cleared during the FEES or MBS
- Can result in “airway invasion” post-swallow
- May increase oral or pharyngeal residue
- Could possibly lead to dehydration
- Reduced Quality of Life
- Taste
- Size of portion
- Activities that surround eating/drinking can become less enjoyable
- Outpatient vs. Inpatient treatment
Inpatients are easily managed on their modified diets, but outpatients may no longer be following it
- Can aspirate saliva
- Less saliva, swallowing less, “use it or lose it”
- Water protocol group and thickened liquid group
- 2 weeks later…
- No on diagnosed with pneumonia
- Water protocol group- increased hydration status
- Thickened Liquid group- decreased hydration status and higher rates of UTI
