The Hydration Status of Adult Patients with Oropharyngeal Dysphagia and the Effect of Thickened Fluid Therapy on Fluid Intake and Hydration: Results of Two Parallel Systematic and Scoping Reviews

Abstract

Background: The effect of oropharyngeal dysphagia (OD) and thickened fluid (TF) therapy on hydration status has not been well defined in the literature. We aimed to assess the hydration status in patients with OD and the effect TF therapy has on it. Methods: Two literature reviews following PRISMA methodology (each one including a systematic and a scoping review) were performed: (R1) hydration status in adult patients with OD; (R2) effect of TF therapy on fluid intake and dehydration. Narrative and descriptive methods summarized both reviews. Quality assessment was assessed by Joanna Briggs Institute tools and GRADE. Results: (R1) Five out of twenty-two studies using analytical parameters or bioimpedance showed poorer hydration status among OD and 19–100% prevalence of dehydration; (R2) two high quality studies (total of 724 participants) showed positive effects of TF on hydration status. Among the articles included, nine out of ten studies that evaluated fluid intake reported a reduced TF intake below basal water requirements. Conclusions: Dehydration is a highly prevalent complication in OD. There is scientific evidence on the positive effect of TF therapy on the hydration status of patients with OD. However, strict monitoring of fluid volume intake is essential due to the low consumption of TF in these patients.

Home caregiver strategies for feeding older adults with dysphagia after dehospitalization

“…It is inferred that refusal to drink liquids by some older adults can lead to dehydration problems, impacting their health in general. Caregivers who understand the importance of safe daily water intake for older adults are alert to possible signs of an inadequate supply ( 17 , 18 ) . In this study, an older adult presented restrictions on oral food consistency and refused to drink liquids.…”

“…Caregivers had reported that, before hospitalization, there was already this refusal even after trying to taste the water. Not drinking fluids leads to skin dehydration and can affect the brain functioning, leading to confusion, difficulty concentrating and cognitive impairment, as well as causing muscle weakness and dizziness, increasing the risk of falls ( 17 , 18 , 19 , 20 ) .…”

“…The sitting posture facilitates chewing and swallowing, preventing choking and improving the effectiveness of digestion. Furthermore, it reduces the risk of acid reflux and gastric discomfort after meals ( 18 , 22 , 23 ) . International studies indicate that placing older adults sitting in bed with the help of pillows or at the table next to family members is a careful and attentive approach that ensures the appropriate posture for receiving food ( 24 , 25 ) .…”

Shear-Viscosity-Dependent Effect of a Gum-Based Thickening Product on the Safety of Swallowing in Older Patients with Severe Oropharyngeal Dysphagia

“…This clinical trial included 85 patients who were recruited from August 2020 to August 2022 at the Gastrointestinal Physiology Laboratory of the Hospital de Mataró, Consorci Sanitari del Maresme (CSdM), Catalonia, Spain. The study recruitment process was severely delayed due to the COVID-19 pandemic [ 15 ].…”

Economic Evaluation of Clinical, Nutritional and Rehabilitation Interventions on Oropharyngeal Dysphagia after Stroke: A Systematic Review

“…OD is highly prevalent in the acute stroke phase (40–78%), and although improvements can be observed during post-stroke recovery, it becomes a chronic condition in up to half of cases [ 1 , 3 , 4 , 5 ]. Post-stroke OD (PS-OD) impairs the efficacy and safety of swallowing, which causes severe complications such as dehydration, malnutrition, respiratory infection, aspiration pneumonia, hospital readmission and death [ 6 , 7 , 8 , 9 ]. PS-OD leads to a deterioration in the health status of patients, and it is an independent risk factor for longer hospital stay, institutionalisation after hospital discharge, poorer functional capacity and increased mortality 3 months after stroke [ 3 ].…”