Re-examining the Use of Thickened Liquids among Patients with Dysphagia

The use of thickened liquids is a frequent recommendation by many speech-language pathologists to minimize or eliminate the possibility of oral aspiration of liquids. The basic premise supporting the use of thickened liquids is that increased viscosity results in a slower transit time and allows for greater control of the bolus, thus providing more time to trigger a pharyngeal swallow. In theory, then, the use of thickened liquids should reduce chances of aspiration. In practice, however, this assumption does not always hold true. For example, patients with dementia have been shown to continue to aspirate with thickened liquids of varying viscosity, from nectar to honey-thick liquids [1]. Furthermore, increased viscosity may not necessarily reduce adverse effects associated with aspiration, as evidenced by a higher rate of pneumonia among patients with dementia who were given honey thick liquids compared to those given nectar-thick liquids [2]. To date, there is a paucity of data to support the benefits of thickened liquids [3] but the emerging evidence suggests that the use of thickened liquids not “a one size fits all” approach and individual patient characteristics must be taken into account.