Modifying the consistency of food and fluids for swallowing difficulties in dementia

Abstract

Background People with dementia can have feeding and swallowing difficulties (dysphagia). Modification of the consistency of food or fluids, or both, is a common management strategy. However, diet modification can affect quality of life and may lead to dehydration and malnutrition. Evidence on the benefits and risks of modifying food and fluids is mandatory to improve the care of people with dementia and dysphagia. Objectives To determine the effectiveness and adverse effects associated with modifying the consistency of food and fluids in improving oral intake and eliminating aspiration in adults with dysphagia and dementia. Search methods We searched ALOIS (the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group), the Cochrane Library, MEDLINE via Ovid SP, Embase via Ovid SP, PsycINFO via Ovid SP, CINAHL via EBSCOhost, LILACS via BIREME, ClinicalTrials.gov and the World Health Organization (WHO) Portal on 9 May 2018. We also checked the reference lists of relevant articles to identify any additional studies. Selection criteria We included randomised controlled trials (RCTs), quasi-RCTs and cluster-RCTs published in any language that measured any of the outcomes of interest. We included trials with adults with a clinical diagnosis of dementia with symptoms and signs of dysphagia confirmed on instrumental assessment. We included participants with all types, stages and severities of dementia. Control groups received either no intervention or interventions not involving diet modification or modification to sensory properties of food. Data collection and analysis Two review authors independently assessed for inclusion all potential studies identified. Data were extracted independently along with assessment of methodological quality using standard Cochrane methods. We contacted study authors for additional unpublished information. 1 Modifying the consistency of food and fluids for swallowing difficulties in dementia (Review)

Preventing Aspiration Pneumonia Among the Elderly: A Review Focused on the Impact of the Consistency of Food Substances

“…The terminology and definitions of different food and fluid consistencies vary and there is currently no international consensus regarding the terminology that should be used for different consistencies of foods and fluids [80]. For instance, the National Dysphagia Diet is comprised of four levels of food modification with specific food items recommended at each level, namely 1…”

Dysphagia and mealtime difficulties in dementia: Speech and language therapists’ practices and perspectives

“…Reliance on thickened fluids could be concerning, however, considering that the research indicates that the short‐term benefits in reducing aspiration risk may have longer term impacts on health and well‐being (Flynn et al . 2018). Further exploration of the longer term effects of modified food and fluids is necessary if SLTs wish to continue using them with this population.…”

“…Whilst intervention should be tailored to the unique needs of each individual, the research evidence describing dementia‐related differences in response to dysphagia interventions, and varying dysphagia profiles associated with different types of dementia (Flynn et al . 2018, Alagiakrishnan et al . 2013) highlights the need to consider type and stage in management decisions.…”

“…In their Cochrane review, Flynn et al . (2018) argue that while fluid viscosity modifications may reduce a person with dementia's short‐term risk of aspiration, they may also lead to adverse outcomes in the longer term, namely respiratory health and nutrition and hydration status complications. Long‐term care residents on texture‐modified diets also have an increased risk of malnutrition, particularly if they have concomitant feeding or cognitive issues (Vucea et al .…”

Swallowing Disorders in the Older Population

“…They found that both nectar‐ and honey‐thick liquids reduced videofluoroscopic aspiration compared to thin liquids. While honey‐thick liquids were associated with higher rates of pneumonia compared to chin tuck posture with thin liquids, the study was not adequately powered for pneumonia as an outcome.…”