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
  • 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

  • Saliva
    • Can aspirate saliva
    • Less saliva, swallowing less, “use it or lose it”
  • Reflux of gastric contents
  • Study from Swallow Your Pride podcast- Is there an impact on health status from thin liquid aspiration post stroke?
    • 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