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Suffolk Center for Speech

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Diet Modification for Individuals with Dysphagia

By: Cara Kennedy

Suffolk Center for Speech

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
    by Suffolk Center for Speech | with 0 Comments

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