Healthy people can tolerate these factors and cleanly direct liquids past the airway and into the oesophagus. In order to reduce the likelihood of aspiration, liquid thickness is often altered.ĭuring oral manipulation and swallowing, liquid flow is turbulent, resulting in eddies and vortices. Complications of dysphagia include chest infection, and in some cases death due to choking on food, or as a result of aspiration pneumonia. Difficulty may be experienced coordinating breathing, swallowing and bolus transport in order that the bolus enters the oesophagus rather than the airway. Problems may occur with oral preparation, or containment of food or liquids within the mouth. ĭysphagia results from many conditions such as: stroke, Motor Neurone disease, Parkinson’s disease, dementia, head and neck cancer, head injury and others. Swallowing difficulty (dysphagia) has a prevalence of 13% in community dwelling elders, approximately 25% of hospitalized individuals and rises to 60% or more of elderly residents living in skilled nursing facilities. The ability to eat and drink is essential to survival and fundamental to the social fabric of society. Individuals are surviving stroke, and many are living to an age where the specter of dementia becomes more of a certainty. Better medical care, improved medication and public health promotion has improved life expectancy. In Australia, people over 70 years are expected to make up 20% of the population by 2051. The National Research Council of the National Academies (USA) is anticipating that the ratio of people aged 65+ yrs to those aged 20–64 years will increase by 80% by the year 2050. The percentage of people aged 65 yrs or more is growing rapidly, causing governments to plan urgently for the long-term implications of aging with one in 13 anticipated to require aged care. Given the aged population forecasts for the year 2050, improved dysphagia management should be a high priority. Consultation with pharmacy and dietetic staff is essential for optimum management of individuals with dysphagia. Clinicians are encouraged to prescribe the minimal level of thickness needed for swallowing safety. Provision of “spoon-thick” or “extremely thick liquids” is particularly likely to contribute to dehydration and poor bioavailability of solid dose medication. The physical property of viscosity rather than a particular thickening agent appears to be key. This review provides evidence from the dysphagia, pharmaceutical and food technology literature to show unintended side effects of thickened liquids that contribute to dehydration and potential sub-theraputic medication levels for individuals with dysphagia. A combination of poor flavour, and increasing feelings of fullness result in little motivation and poor physiologic drive to consume thickened liquids. Yet small volumes of thick substances consumed with a long oral processing time, which is common for individuals with dysphagia, reduces the amount consumed. Therapeutically clinicians often prescribe small volumes of thickened liquids, consumed often. Flavour deteriorates with increasing thickness regardless of thickening agent. In addition, feelings of satiety and thirst increase with increasingly viscous fluids. Liquids thickened to as little as 150 mPa.s retards drug release. However, bioavailability of medication is impaired with viscous substances. This effect holds true even for extremely thick fluids. Thankfully, regardless of thickening agent, thickeners do not affect water bioavailability. Initial concerns were raised about the impact of thickeners on water binding due to the high prevalence of dehydration amongst individuals with dysphagia. Although thickened liquids improve swallow safety, they appear to have a great potential for unintended physiological consequences. A range of starches and gums has historically been used to thicken liquids. Thickened liquids are often used in the management of dysphagia to improve bolus control and to help prevent aspiration. Dysphagia is the medical term for difficulty swallowing.
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