[Dysphagia] Thickened liquids

[chris_claire at bigpond.com (Chris and Claire Langdon)]

Hi Valerie

You may be interested in a website http://www.kon.org/urc/biggs_cooper.html 
Abstract :The purpose of this study was to compare the physical properties of nectar and honey-thickened juices, which are often clinically recommended in dysphagia diets. The viscosity (thickness) of four brands of powdered thickeners mixed with apple and orange juice was measured at two and 10-minute intervals. Results indicated that: (a) viscosity varied across powdered thickeners, (b) orange juice was typically more viscous than apple juice, and (c) honey thick consistencies became more viscous when allowed to thicken for a longer time period for three of four thickeners. The results are discussed in terms of their clinical implications for people with disordered swallowing (dysphagia). 
and also

Cichero JA, Jackson O, Halley PJ, Murdoch BE. Which one of these is not like the others? An inter-hospital study of the viscosity of thickened fluids.J Speech Lang Hear Res. 2000 Apr;43(2):537-47. 
Abstract: This investigation examined the rheological (viscosity and yield stress) and material property (density) characteristics of the thickened meal-time and videofluorscopy fluids provided by 10 major metropolitan hospitals. Differences in the thickness of thickened fluids were considered as a source of variability and potential hazard for inter-hospital transfers of dysphagic patients. The results indicated considerable differences in the viscosity, density, and yield stress of both meal-time and videofluoroscopy fluids. In theory, the results suggest that dysphagic patients transferred between hospitals could be placed on inappropriate levels of fluid thickness because of inherent differences in the rheology and material property characteristics of the fluids provided by different hospitals. Slowed improvement or medical complications are potential worst-case scenarios for dysphagic patients if the difference between the thick fluids offered by 2 hospitals are extreme. The investigation outlines the most appropriate way to assess the rheological and material property characteristics of thickened fluids. In addition, it suggests a plan of quality improvement to reduce the variability of the thickness of fluids offered at different hospitals.


There's also an article that discusses the prevalence of thickened fluid use in US skilled nursing facilities
Castellanos, V.H., et al., Use of thickened liquids in skilled nursing facilities. J Am Diet Assoc, 2004. 104(8): p. 1222-6.
OBJECTIVE: Long-term care residents are routinely provided with thickened liquids for the management of dysphagia. The objective of this study was to identify the prevalence of thickened liquid use in skilled nursing facilities. DESIGN: Facility-wide data were provided by staff at 252 randomly selected skilled nursing facilities owned by 11 multifacility providers. The sample represented 25,470 residents and approximately 20% of all freestanding skilled nursing facilities nationwide. MAIN OUTCOMES MEASURES: Data regarding prevalence of thickened liquid use and facility characteristics were collected during May 2002.Statistical analysis Descriptive statistics included national and regional averages and national percentile distributions. RESULTS: A mean of 8.3% (range 0% to 28%) of residents were receiving thickened liquids, with considerable variation between Centers for Medicare and Medicaid Services regions. Of those receiving thickened liquids, on average 60% received "nectar/syrup" thick, 33% received "honey" thick, and 6% received "pudding/spoon" thick, although the frequencies with which each thickness was prescribed varied widely between facilities (range 0% to 100%). Thickened water was provided to residents in 91.6% of facilities. Nationally, registered dietitian staffing levels were lower on average than speech language pathologist staffing levels. CONCLUSIONS: Thickened liquids are provided to a significant segment of the skilled nursing facility resident population. In the absence of outcomes-based practice standards to guide administrative decisions related to the provision of thickened liquids, dietetics professionals may find regional and national norms helpful for quality assurance processes and to inform resource management decisions in clinical staffing and foodservice.
Finally, there's the problem of the difference between Newtonian and non-Newtonian fluids in relation to thickeners - not all liquids behave the same.  See http://www.coleparmer.com/techinfo/techinfo.asp?htmlfile=HVFlow_WP.htm.  Anecdotally, there's been differences found in fluid thickness for fruit juices - the same recipe, careful measuring, same brand of juice - turned out to be based on seasonal variations in the sort of oranges used by the juice manufacturer!

Best regards

Claire

----- Original Message ----- 
From: <sorriso@adelphia.net>
To: <spunkles@hotmail.com>
Cc: <Dysphagia@b9.com>
Sent: Sunday, June 12, 2005 8:05 PM
Subject: Re: [Dysphagia] Thickened liquids


> Good luck with this Valerie!  The subject has been discussed before (search for it in the archives) and I believe  the upshot was that there is no way to quantify thickness in our real life settings.
> 
> I'd like to suggest that any thickened liquid may be too thick.  Have you screened/evaluated these folks lately to see if they can tolerate thin liquids?  
> 
> Our rehab company picked up a new building two years ago in which approximately 10 of the patients were on thickened (from nectar to spoon thick) and none had been re-evaled.  I picked them up, a couple at a time, and every single one of these people were able to go to thin and remain on thin with no dire consequences.  
> 
> They fell into two groups:  some had been downgraded when ill and never re-evaled when they got better or admitted long-term care from the hospital, never identified and continued on thickened when they got better.  People do get better!
> 
> Linda A. Zanchi, MA, CCC-SLP
> 
> 
> ---- Valerie Hartleb <spunkles@hotmail.com> wrote: 
> > Please help me!  I work in a nursing home and I have battling the 
> > administration re: how thick liquids should be when people are on nectar and 
> > honey.  I believe the nursing home is overthickening resident's liquids in 
> > return causing resident's not wanting to drink.  Please provide a 
> > explanation re: how thick liquids really should be.  I would value anyone's 
> > opinion on this matter.  Thank you very much and I look forward to hearing 
> > from you.
> > 
> > Thank you,
> > Valerie--Kalamazoo, MI
> > 
> > 
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