Thick Liquids and Clinical Outcomes in Hospitalized Patients With Alzheimer Disease and Related Dementias and Dysphagia

Abstract

ImportanceOropharyngeal dysphagia is common in hospitalized patients with Alzheimer disease and related dementias (ADRD). Although the use of thick liquids in patients with dysphagia has been shown to reduce aspiration on direct visualization, there is no clear evidence that this practice translates into improved clinical outcomes.ObjectivesTo determine whether a diet of thick liquids compared with thin liquids is associated with improved outcomes in hospitalized patients with ADRD and dysphagia.Design, Setting, and ParticipantsThis cohort study included adults aged 65 years and older with ADRD who were admitted to the medicine service across 11 diverse hospitals in New York between January 1, 2017, and September 20, 2022, with clinical suspicion of dysphagia during hospitalization and survival for at least 24 hours after hospital arrival. Patients were grouped according to whether at least 75% of their hospital diet consisted of a thick liquid diet or a thin liquid diet. Propensity score matching was used to balance covariates across the 2 groups for the following covariates: demographics (eg, age, sex), baseline clinical characteristics (eg, Charlson Comorbidity Index), and acute presentation (eg, respiratory diagnosis, illness severity, delirium).Main Outcomes and MeasuresHospital outcomes included mortality (primary outcome), respiratory complications (eg, pneumonia), intubation, and hospital length of stay (LOS).ResultsOf 8916 patients with ADRD and dysphagia included in the propensity score matched analysis, the mean (SD) age was 85.7 (8.0) years and 4829 were female (54.2%). A total of 4458 patients receiving a thick liquid diet were matched with 4458 patients receiving a thin liquid diet. There was no significant difference in hospital mortality between the thick liquids and thin liquids groups (hazard ratio, 0.92; 95% CI, 0.75-1.14]; P = .46). Compared with patients receiving thin liquids, patients receiving thick liquids were less likely to be intubated (odds ratio [OR], 0.66; 95% CI, 0.54-0.80), but they were more likely to have respiratory complications (OR, 1.73; 95% CI, 1.56-1.91).Conclusions and RelevanceThis cohort study emphasizes the need for prospective studies that evaluate whether thick liquids are associated with improved clinical outcomes in hospitalized patients with ADRD and dysphagia.

The challenge of making better decisions about oral intake in older people with ‘aspiration pneumonia’

“…A recently published study emphasises the need to challenge the common misperception that there is a clear link between aspiration while eating and drinking and pneumonia, and that pneumonia can be prevented by modifying diets such as by thickening liquids. Makhnevich and colleagues performed a retrospective cohort study of 13,168 adults with dementia (mean age 85 years) and a clinical suspicion of dysphagia admitted to 11 hospitals in New York and of whom 34% received thick liquids for most of their admission [13]. In a propensity score matched analysis, patients receiving thick liquids were more likely to have respiratory complications, such as choking, aspiration, or pneumonia (odds ratio (OR) 1.73) than those receiving thin liquids (although less likely to be intubated (OR 0.66)).…”