Dysphagia – The Importance of Hydration (part 3 of series)

This article is part 3 of 4-part series on dysphagia.

Water intake is often a secondary consideration in dysphagia management. Water makes up 75% of the volume of the body. The NHS advises that where appropriate, patients should be drinking 2.5 litres of water per day. Many older people and those with dysphagia do not drink adequate amounts of water, consuming only 480–960mls 2-4 glasses per day.

Drinking enough fluid can assist in preventing or treating the following ailments:

• Pressure ulcers
• Urinary infections and incontinence
• Heart disease
• Diabetes management
• Dizziness and confusion leading to falls
• Skin conditions
• Constipation
• Kidney stones
• Low blood pressure
• Cognitive impairment
• Poor oral health

 

 

Hydration and Dysphagia

Thickened fluids:

One way of helping patients with swallowing problems to take fluids without aspirating is to consume liquid of a thicker consistency. A speech therapist can give advice about thickened fluids. Fluid can be thickened artificially with powder or bought pre-thickened. There are three recognised thicknesses; however, descriptions may vary in each country

• Stage 1:
  Leaves a film on the back of a spoon. Can be drunk from a cup.
• Stage 2:
  Leaves a thick coating on the back of a spoon. Can be drunk slowly from a cup.
• Stage 3:
  Has to be spoon fed. Cannot be drunk from a cup.

 

 

Positioning:

The position in which you drink can also affect swallowing.

One study has shown that:

“The chin down posture can have a positive effect on swallowing safety and reduce the incidence of aspiration and depth of penetration, in the context of cup drinking with thin liquids.” Fraser (2012)

Specialist dysphagia drinking devices are designed to aid drinking with a chin down posture. They are shaped to accommodate the nose which allows the cup to be fully emptied. There are other different postures and positions which you may be advised to adopt by your speech therapist that can also help with a more effective swallow. It is important to receive the correct advice.

Drinking smaller quantities with each sip:

It is possible that limiting the amount of fluid consumed with each swallow can also make swallowing safer. For example, when recovering from a stroke you may be initially restricted to a 5cc teaspoonful of fluid.

Drinking devices are available which restrict the volume of fluid delivered with each tip of the cup (e.g. Drink-Rite). Sometimes those with learning difficulties or dementia may gulp fluid too quickly, risking aspiration. A controlled flow drinking cup like Drink-Rite will help to minimise the risk of aspiration when drinking too quickly.

Part 4 of this series – ‘Drinking Cups and Mugs for Dysphagia’ – identifies several of the cups and mugs available to help make dysphagia more manageable. Click here to read it now.