Thickened Liquids = Substandard Oral Fluid Intake = Dehydration. Is It Really That Simple?

Abstract

“Thickened liquids” generally elicits a negative reaction to those who have had experience with them. The altered taste, texture, and consistency of thickened liquids has long been thought to be the primary reason for substandard fluid intakes in patients with dysphagia who are restricted to thickened liquids. However, recent studies suggest that individuals who have no restrictions on liquid consistency also exhibit substandard fluid intake. Factors including functional deficits post-stroke, environmental barriers, and the amount of fluids offered have been reported to influence oral fluid intake for hospitalized individuals regardless of liquid viscosity. While thickened liquids have received criticism for contributing to dehydration, another treatment in dysphagia, the “Water Protocol,” has generated a positive response in improving not only quality of life, but also hydration while maintaining respiratory health. Despite recent studies suggesting that aspirating water does not result in adverse events in individuals who are known to aspirate, there are many unreported variables that could alter the outcomes. Dysphagia severity, or more specifically, aspiration characteristics, may influence how well an individual tolerates a water protocol. Understanding the variables that can influence outcomes in dysphagia research is crucial before a treatment can be considered efficacious.