MDS Alert

Published on Sun May 01, 2011 PDF

These strategies may allow some residents to safely drink regular liquids.

Thickened liquids can help prevent aspiration, but many residents with swallowing problems resist giving up their usual beverages. Facilities can, however, help residents balance safety with quality of life in this area of care.

Trend: "As a field, we are moving away from over-prescribing thickened liquids and more and more looking at which people can safely stay on some thin liquids," says Nancy Swigert, MA, CCC-SLP, BRS-S, director of speech-language pathology and respiratory care at Central Baptist Hospital in Lexington, Ky.

Conundrum: "The tricky thing is we don't know which patient with dysphagia will get pneumonia and which one won't," says Swigert. "The medical team has to look at the whole picture and other risk factors to help the person/family make an informed consent about whether to have thickened liquids."

The risk factors, says Swigert, include the following:

Also: "Some people cough so violently when they aspirate a little that they don't want to drink thin liquids."

Some patients can't safely drink thin liquids, Swigert says. But she thinks nursing facilities often can enhance residents' quality of life by having them drink thin liquids with designated staff supervising them and/or by using special techniques.

For example, you can provide liquids a teaspoon at a time, Swigert points out. Or staff can offer liquids in a cup that controls the "sip size." There are also straws that won't allow fluid to drop back down in the straw when you draw it up through the straw, she adds. You can "use a cut-out cup where you don't have to tip your head back to drink." Some residents will require supervision when they drink thin liquids, she notes.

Sidestep this problem: "Thickened liquids are not very palatable," cautions Swigert. "So if people don't drink enough of them, they may become poorly hydrated." Keep in mind that people find naturally thick liquids more appetizing -- examples include tomato juice, a yogurt drink, some nectars, and buttermilk, she adds.

Tip: When people refuse thickened liquids, Annette Kobriger, RD, MPH, MPA, tries giving them yogurt with pureed fruit in it, which is a "normal food they would eat." And it's a source of calcium. Or "instead of a glass of milk, they'd have six ounces of pudding," adds Kobriger, principal of Kobriger Presents LLC in Chilton, Wis.