I frequently work with patients dealing with swallowing disorders. For years, I cautiously recommended modified diets requiring thickened liquids, knowing that we had limited appealing options.
“Please! Don’t put that snow in my coffee!” one patient pleaded.
My recommendations directly affect patient well-being, but the challenge was getting them to comply. Plus, many patients ran a higher risk of dehydration because they avoided drinking thick, grainy liquids.
Our conventional tray service included portion-controlled aseptic and foiled-covered containers, powdered coffee and thickening-powder packets. The limited options for pre-mixed juices were cranberry, orange or apple juice, all thickened with a non-water soluble thickening agent.
We were frequently approached with complaints from patients regarding the limited variated and poor quality of the liquids we were offering. Additionally, our nursing staff equally disliked using powder thickener, as it was messy, time-consuming and frequently refused by patients. So, we decided to change not only what we provided to our patients, but how we offered it.
Our new system involved several simple changes:
- To minimize spillage as well as the need for assistance, pre-thickened milk, juice and flavored beverages get portioned into translucent cups with easy-to-open lids. For example, 4 oz. of liquid goes into 7-oz. cups, and 8 oz. of liquid into 12-oz. cups. Residents have more confidence holding cups that are not filled to the top with liquid. Beverages served in regular cups—rather than foil-sealed containers—also look “normal,” helping to preserve the residents’ dignity.
- New innovations in pre-thickened water and beverages allow us to portion thickened liquids before serving them. These xanthan-gum-based products also maintain consistency over time and produce meals that are more palatable to patients. For example, our kitchen takes flavorless pre-thickened water and mixes in different tastes—lemonade, kiwi and mango. They also use it to thicken soups, coffee and tea. The options seem endless!
- Prior to changing our system, I couldn’t offer patients a simple glass of ice water. Now, we even freeze thickened water in ice-cube trays and offer a glass of unflavored thickened ice water without compromising the viscosity of the liquid.
Based on our observations, as well as patient reports, we found our patients significantly prefer the new pre-thickened menu used those last weeks. Now that they’ll drink thickened liquids, they also more willingly alternate solids and liquids—one of the most common compensatory strategies used to manage dysphagia.
Our October issue dives deep into dysphagia treatment:
We also found that our new system resulted in a significant increase in both food and fluid intake. Overall fluid intake increased by 15 percent, food intake during meal times increased by 25 percent, and hydration or snacks during medication pass and bedside increased by 25 percent.
People living with dysphagia can enjoy meal time. It just takes a few simple innovations to give patients “their cup of tea”—literally—in a palatable, thickened form.
Here are some additional dysphagia resources:
Jennifer Baquet, MA, CCC-SLP, is a senior clinician with Language Fundamentals, which provides services at the Amsterdam Nursing Home in New York City. Jbaquet@langfun.com.