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Venkat S. Improving swallowing function with thickening agents in post-stroke oropharyngeal dysphagia: a real-world experience. Curr Med Res Opin 2024; 40:1163-1170. [PMID: 38864410 DOI: 10.1080/03007995.2024.2365406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/04/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Post-stroke dysphagia (PSD) is a widely prevalent and possibly life-threatening consequence that may lead to aspiration pneumonia, malnutrition, dehydration, and higher mortality risk. Recommending thickened fluids (TF) is a longstanding practice in the management of dysphagia. Augmenting liquid viscosity with a xanthan gum-based thickener benefits patients with PSD by aiding in the enhancement of bolus control, facilitating improved coordination in the swallowing mechanism, and lowering the risk of aspiration. Despite the widespread use of TF, limited high-quality evidence supports its benefits in PSD. CASE REPORT This manuscript presents the clinical experience with four varied cases of PSD. A comprehensive approach to management with TF decreased the risk of aspiration pneumonia and facilitated effective management of dietary recommendations both during hospitalization and after discharge (all Cases). In addition, TF maintained nutrition and hydration in patients with multiple hospital admissions (Case 2), maintained hydration in those unable to engage in swallow rehabilitation due to complex medical conditions (Cases 2, 3, and 4), and those who needed slow and longer recovery due to long-term risk of silent aspiration (Cases 2, 3, and 4). In one case (Case 4), the use of TF was extended for more than two years post-stroke with no reported incidence of chest infection. CONCLUSION In routine clinical practice, a comprehensive management approach with xanthan gum-based TFs reduces the risk of aspiration and aspiration pneumonia in patients with PSD while maintaining nutritional and hydration and improving swallowing function based on formal instrumental assessments. This clinical experience highlights the pivotal role of instrumental assessment, patient education, and informed decision-making to optimize outcomes with TF.
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McCurtin A, Byrne H, Collins L, McInerney M, Lazenby-Paterson T, Leslie P, O'Keeffe S, O'Toole C, Smith A. Alterations and Preservations: Practices and Perspectives of Speech-Language Pathologists Regarding the Intervention of Thickened Liquids for Swallowing Problems. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:117-134. [PMID: 37889208 DOI: 10.1044/2023_ajslp-23-00226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE The intervention of thickened liquids (TL) is commonly used to reduce aspiration in people with dysphagia. Speech-language pathologists (SLPs) have traditionally believed it is an effective intervention. Recent articles highlight limited evidence, poor acceptance, and a variety of unintended consequences. This study explores if current debates have been reflected in SLP practices and perspectives. METHOD An e-survey was developed. Participants were recruited via professional associations in Australia, New Zealand, Ireland, the United Kingdom, and the United States. Descriptive and inferential statistics were used to explore the data. Principal component analysis was used to summarize SLP practices and perspectives. RESULTS The 370 respondents represented mainly experienced, confident, hospital-based clinicians. While 20% of respondents frequently recommend TL, 61% believe it to be a burdensome treatment. "Best treatment" and "It works" beliefs continue to underpin decision making. Those who recommend TL most often are most influenced by penetration, coughing, and their own clinical experience. They are more likely to believe TL is evidence based and effective, reduces aspiration, and improves hydration. Person-centeredness is important among all respondents, although significant numbers would implement TL against patient wishes. Improvements in aspiration status and quality of life rank highly as reasons to discontinue TL. CONCLUSIONS The results of this study suggest that fewer respondents are regularly using TL. Divergent groups are evident with those frequently employing and believing in the efficacy of TL and those who do not. While current debates are influencing practice, there clearly remains a significant number of SLPs continuing to recommend TL. This study's findings highlight both alterations and preservations in the discipline's approach to TL and calls for SLPs to reframe our thinking regarding this intervention as well as consider alternative options in this treatment space. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24317110.
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Affiliation(s)
- Arlene McCurtin
- School of Allied Health, University of Limerick, Ireland
- Health Research Institute, Health Implementation Science and Technology Research Cluster, University of Limerick, Ireland
- Swallow Perspectives, Advocacy and Research Collective (SPARC), University of Limerick
| | - Hannah Byrne
- School of Allied Health, University of Limerick, Ireland
| | - Lindsey Collins
- Swallow Perspectives, Advocacy and Research Collective (SPARC), University of Limerick
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, United Kingdom
| | - Michelle McInerney
- School of Allied Health, University of Limerick, Ireland
- Swallow Perspectives, Advocacy and Research Collective (SPARC), University of Limerick
- CP-ACHIEVE in Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Tracy Lazenby-Paterson
- Swallow Perspectives, Advocacy and Research Collective (SPARC), University of Limerick
- Intellectual (Learning) Disability Service, NHS Lothian, Edinburgh, United Kingdom
| | - Paula Leslie
- Swallow Perspectives, Advocacy and Research Collective (SPARC), University of Limerick
- Newcastle External Assessment Group, Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Trust, United Kingdom
- Center for Bioethics and Health Law, University of Pittsburgh, PA
| | - Shaun O'Keeffe
- Swallow Perspectives, Advocacy and Research Collective (SPARC), University of Limerick
- Department of Geriatric Medicine, Galway University Hospitals, Ireland
| | - Claire O'Toole
- School of Allied Health, University of Limerick, Ireland
| | - Alison Smith
- Swallow Perspectives, Advocacy and Research Collective (SPARC), University of Limerick
- NHS Hertfordshire and West Essex Integrated Care Board, Hemel Hempstead, United Kingdom
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Werden Abrams S, Gandhi P, Namasivayam-MacDonald A. The Adverse Effects and Events of Thickened Liquid Use in Adults: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2331-2350. [PMID: 37437527 DOI: 10.1044/2023_ajslp-22-00380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
PURPOSE Practice pattern studies suggest that liquid modification is currently a primary strategy used by speech-language pathologists to manage dysphagia; however, the breadth of negative consequences associated with their use is not well understood. The purpose of this review was to summarize the evidence on adverse events and effects of thickened liquid (TL) use in adults. METHOD Six databases were searched in February 2022: EMBASE, MEDLINE (PubMed), Speechbite, AMED, AgeLine, and CINAHL. Articles were included if they compared adults receiving different TL viscosities and discussed at least one adverse event or effect of consuming TLs. Articles were excluded if they were review articles, rehabilitation studies, rheological analyses, not in English, or not peer reviewed. Screening and data extraction were completed by two independent reviewers. Risk of bias was assessed using Cochrane tools. RESULTS Thirty-three studies (N = 4,990 participants across all studies) were eligible for inclusion (2,405 unique records screened). Reported adverse events included dehydration (n = 5), pneumonia (n = 4), death (n = 2), urinary tract infection (n = 1), and hospitalization (n = 1); adverse effects included reduced quality of life (n = 18), aspiration (n = 12), reduced intake (n = 8), increased residue (n = 4), and reduced medication bioavailability (n = 2). Results were mapped on to codes and domains of the International Classification of Functioning, Disability and Health. CONCLUSIONS A range of adverse outcomes associated with TL use were identified. Adverse outcomes should be monitored and reported in dysphagia research. Given current research evidence, it is vital for clinicians to weigh the risks and benefits of TL use to mitigate potential adverse outcomes.
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Affiliation(s)
- Sophia Werden Abrams
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Pooja Gandhi
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
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D'Netto P, Rumbach A, Dunn K, Finch E. Clinical Predictors of Dysphagia Recovery After Stroke: A Systematic Review. Dysphagia 2023; 38:1-22. [PMID: 35445366 PMCID: PMC9873776 DOI: 10.1007/s00455-022-10443-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/28/2022] [Indexed: 01/28/2023]
Abstract
Oropharyngeal dysphagia is common post-stroke and can have serious consequences for patients. Understanding dysphagia recovery is critically important to inform prognostication and support patients and professionals with care planning. This systematic review was undertaken to identify clinical predictors of dysphagia recovery post-stroke. Online databases (EMBASE, Scopus, Web of Science, PubMed, CINAHL, and Cochrane) were searched for studies reporting longitudinal swallowing recovery in adults post-stroke. Dysphagia recovery was defined as improvement measured on a clinical swallowing scale or upgrade in oral and/or enteral feeding status by the end of the follow-up period. The search strategy returned 6598 studies from which 87 studies went through full-text screening, and 19 studies were included that met the eligibility criteria. Age, airway compromise identified on instrumental assessment, dysphagia severity, bilateral lesions, and stroke severity were identified as predictors of persistent dysphagia and negative recovery in multiple logistic regression analysis. The available literature was predominated by retrospective data, and comparison of outcomes was limited by methodological differences across the studies in terms of the choice of assessment, measure of recovery, and period of follow-up. Future prospective research is warranted with increased representation of haemorrhagic strokes and uniform use of standardized scales of swallowing function.
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Affiliation(s)
- Pamela D'Netto
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia.
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia.
- Speech Pathology Department, Ipswich Hospital, West Moreton Health, Ipswich, Australia.
| | - Anna Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
| | - Katrina Dunn
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
- Speech Pathology Department, Ipswich Hospital, West Moreton Health, Ipswich, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
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Ahn HJ, Chun MH, Lee J. Compliance and effect of thickener use in dysphagia patients with brain lesions: An observational pilot study. Medicine (Baltimore) 2022; 101:e30600. [PMID: 36197259 PMCID: PMC9509132 DOI: 10.1097/md.0000000000030600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The study aimed to investigate the status of thickener use in dysphagia patients with brain lesions and incidence of adverse events based on fluid viscosity. Twenty dysphagia patients with brain lesions who were recommended to use thickeners following a videofluoroscopic swallowing study were enrolled in this observational pilot study. Patients were educated to use thickener as level 2 or 3 based on the International Dysphagia Diet Standardization Initiative flow test. We evaluated the viscosity of the fluid that patients drank once a week for 2 weeks, and reviewed medical records regarding adverse events. Patients were divided into 2 groups based on the average value obtained from the viscosity evaluations as thin (Levels 0-2) and thick fluid groups (Levels 3-4). Adverse events were compared between the groups. The number of patients who did not follow the recommendations increased from 35.0 to 45.0% during the 1-week follow-up period. No patient developed pneumonia or urinary tract infection. Constipation (P = 0.338) and dehydration status (P = 0.202) were not significantly different between the 2 groups. In 2 evaluations for 20 patients, 40.0% of the cases did not follow the educated viscosity, and the number gradually increased in the follow-up evaluation. Considering that there were no significant differences in the incidence of adverse effects including pneumonia according to the fluid viscosity, a further study is necessary to establish detailed criteria for thickener use in dysphagia patients with brain lesions.
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Affiliation(s)
- Hye Joon Ahn
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- *Correspondence: Min Ho Chun, Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea (e-mail: )
| | - Junekyung Lee
- Department of Rehabilitation Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Gyeonggi-do, Republic of Korea
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Garcia JM, Chambers E, Yarrow K. Thickened liquids for dysphagia management: A call to action in the development of educational and instructional strategies. J Texture Stud 2021; 52:679-683. [PMID: 33890326 DOI: 10.1111/jtxs.12603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/08/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022]
Abstract
This article is a "call to action" in the service delivery of thickened liquids. We discuss the importance of staff education and further development of educational resources in dysphagia management involving the use of thickened liquids, particularly as related to inadequacies in staff education and training. We discuss the use of contemporary instructional strategies to promote accuracy in preparation and knowledge about the thickening process.
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Affiliation(s)
- Jane Mertz Garcia
- Communication Sciences & Disorders, Department of Applied Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Edgar Chambers
- Department of Food, Nutrition, Dietetics & Health, Kansas State University, Manhattan, Kansas, USA
| | - Katie Yarrow
- Communication Sciences & Disorders, Department of Applied Human Sciences, Kansas State University, Manhattan, Kansas, USA
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Emmerich K, Müller-Simianer E, Penner H, Zieschang T. Dysphagietherapie in der Geriatrie: Abwägungen zwischen Lebensqualität und Risiko – eine qualitative Studie. Ethik Med 2020. [DOI: 10.1007/s00481-020-00597-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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McCurtin A, Brady R, Coffey K, O'Connor A. Clarity and contradictions: speech and language therapists' insights regarding thickened liquids for post-stroke aspiration. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Oropharyngeal dysphagia is a common condition following stroke, with adverse consequences including aspiration pneumonia. Internationally, aspiration risk is typically managed using thickened liquids, an intervention with limited empirical support and associated treatment adherence issues. This study explores speech and language therapists' perceptions of and reasons for employing this intervention. Methods A total of 22 speech and language therapists working with people with dysphagia post-stroke in hospital settings participated in three focus groups. Participants were recruited through gatekeeper managers and data were analysed using inductive thematic analysis. Results Three themes were identified: primary justifications for treatment use, acute implementation issues, and having doubts. Use of thickened liquids is pivoted on safety-first reasoning, employed as a first step on the treatment ladder and in the context of limited perceived alternatives. Both clarity and contradictions are revealed by therapists, who acknowledge multiple factors that impact treatment effectiveness, including hospital, patient and product issues. Conclusions The findings from this study provide a basis for understanding clinical decision making for a widely-used gateway treatment that requires further empirical support. The data suggest that, similar to other professions, safety-first reasoning is paramount for speech and language therapists. The dominance of thickened liquids in treating aspiration is reflected internationally and warrants ongoing discussion.
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Affiliation(s)
- Arlene McCurtin
- School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ronan Brady
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Katherine Coffey
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Anne O'Connor
- School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Seshadri S, Sellers CR, Kearney MH. Balancing Eating With Breathing: Community-Dwelling Older Adults’ Experiences of Dysphagia and Texture-Modified Diets. THE GERONTOLOGIST 2017; 58:749-758. [DOI: 10.1093/geront/gnw203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Indexed: 11/13/2022] Open
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Horner J, Modayil M, Chapman LR, Dinh A. Consent, Refusal, and Waivers in Patient-Centered Dysphagia Care: Using Law, Ethics, and Evidence to Guide Clinical Practice. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 25:453-469. [PMID: 27820871 DOI: 10.1044/2016_ajslp-15-0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/25/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE When patients refuse medical or rehabilitation procedures, waivers of liability have been used to bar future lawsuits. The purpose of this tutorial is to review the myriad issues surrounding consent, refusal, and waivers. The larger goal is to invigorate clinical practice by providing clinicians with knowledge of ethics and law. This tutorial is for educational purposes only and does not constitute legal advice. METHOD The authors use a hypothetical case of a "noncompliant" individual under the care of an interdisciplinary neurorehabilitation team to illuminate the ethical and legal features of the patient-practitioner relationship; the elements of clinical decision-making capacity; the duty of disclosure and the right of informed consent or informed refusal; and the relationship among noncompliance, defensive practices, and iatrogenic harm. We explore the legal question of whether waivers of liability in the medical context are enforceable or unenforceable as a matter of public policy. CONCLUSIONS Speech-language pathologists, among other health care providers, have fiduciary and other ethical and legal obligations to patients. Because waivers try to shift liability for substandard care from health care providers to patients, courts usually find waivers of liability in the medical context unenforceable as a matter of public policy.
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Affiliation(s)
- Jennifer Horner
- Communication Sciences and Disorders, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens
| | - Maria Modayil
- Individual Interdisciplinary Program, Graduate College, Ohio University, Athens
| | - Laura Roche Chapman
- Communication Sciences and Disorders, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens
| | - An Dinh
- Communication Sciences and Disorders, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens
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Does a Water Protocol Improve the Hydration and Health Status of Individuals with Thin Liquid Aspiration Following Stroke? A Randomized Controlled Trial. Dysphagia 2016; 31:424-33. [DOI: 10.1007/s00455-016-9694-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
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Rogus-Pulia N, Hind J. Patient-Centered Dysphagia Therapy -The Critical Impact of Self-Efficacy. ACTA ACUST UNITED AC 2015. [DOI: 10.1044/sasd24.4.146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nicole Rogus-Pulia
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital
Madison, WI
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
Madison, WI
| | - Jacqueline Hind
- Clinical Affairs, Swallow Solutions
Madison, WI
- School of Medicine and Public Health, University of Wisconsin
Madison, WI
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Murray J, Doeltgen S, Miller M, Scholten I. A survey of thickened fluid prescribing and monitoring practices of Australian health professionals. J Eval Clin Pract 2014; 20:596-600. [PMID: 24814509 DOI: 10.1111/jep.12154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2014] [Indexed: 01/01/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES This study aimed to describe (1) how thickened fluids are supplied to clients with dysphagia; (2) how clients' consumption of thickened fluids and hydration status is monitored; and (3) the impact of institutional factors on thickened fluid intake and hydration in Australian health care settings. METHODS Speech pathologists, dietitians and nurses working in Australian health care settings were asked to voluntarily participate in an online survey that was advertised through their respective professional associations. The questions required a self-report of their practice with respect to thickened fluids. RESULTS Few health care facilities (17%) monitored thickened fluid consumption routinely even though, in the opinion of 51% the respondents, clients on thickened fluids at their facility do not drink enough. Palatability of the thickened fluid products and patients' dependence on others for drinking were thought to have a major impact on fluid intake. Respondents also highlighted institutional factors such as inadequate assistance from staff and inconsistent systems for monitoring fluid intake and signs of dehydration. The most common way to address inadequate intake was for nurses to 'push fluids' (87%). Free water protocols were used only 14% of the time and setting small oral fluid targets throughout the day was the least common strategy (11%). CONCLUSIONS There is a need for Australian health care facilities to educate all clinical staff about the risks of dehydration and develop clinical pathways for clients with dysphagia, which include routine monitoring of oral fluid consumption and dehydration and timely intervention.
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Affiliation(s)
- Jo Murray
- Hampstead Rehabilitation Centre, Adelaide, South Australia; Speech Pathology and Audiology, Flinders University, Adelaide, South Australia
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Abstract
SummaryDysphagia represents a salient concern in many conditions prevalent in older people. There are direct implications for morbidity and mortality. The importance of recognizing and managing dysphagia in hospital and the community also extends to psychosocial impact and quality of life, as well as health, economic and ethical-legal issues. This review outlines reasons for the importance of recognizing and treating dysphagia. It then proceeds to look at recent developments in our understanding of the nature, assessment and management of dysphagia in older people. Whilst there are well-established practices in assessment and management, ongoing work continues to challenge the validity and reliability of many methods. These concerns are covered and directions for future developments highlighted.
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Shim JS, Oh BM, Han TR. Factors associated with compliance with viscosity-modified diet among dysphagic patients. Ann Rehabil Med 2013; 37:628-32. [PMID: 24231801 PMCID: PMC3825938 DOI: 10.5535/arm.2013.37.5.628] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/28/2013] [Indexed: 12/04/2022] Open
Abstract
Objective To investigate compliance with a viscosity-modified diet among Korean dysphagic patients and to determine which factors are associated with compliance. Methods We retrospectively reviewed medical records of patients who had been recommended to use thickeners in the previous videofluoroscopic swallowing study (VFSS). Among 68 patients, 6 were excluded because tube feeding was required due to deterioration in their medical condition. Finally, 62 patients were included in the study. Patient compliance was assessed using their medical records by checking whether he or she had maintained thickener use until the next VFSS. To determine which factors affect compliance, the relationship between thickener use and patient characteristics, such as sex, age, inpatient/outpatient status, severity of dysphagia, aspiration symptoms, follow-up interval of VFSS, and current swallowing therapy status were assessed. For noncompliers, reasons for not using thickeners were investigated by telephone interview. Results Among 62 patients, 35 (56.5%) were compliers, and 27 (43.5%) were noncompliers. Eighteen (90%) of 20 inpatients had followed previous recommendations; however, only 17 (40.5%) of 42 outpatients had been using thickeners. Of patient characteristics, only admission status was significantly correlated with compliance. When asked about the reason why they had not used thickeners, noncompliers complained about dissatisfaction with texture and taste, greater difficulty in swallowing, and inconvenience of preparing meals. Conclusion Among Korean dysphagic patients, compliance with a viscosity-modified liquid diet was only about 50%. Betterments of texture and taste along with patient education might be necessary to improve compliance with thickener use.
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Affiliation(s)
- Jae Seong Shim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
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