Water intake is often a secondary consideration in dysphagia management (6). Water makes up 75% of the volume of the body. Many older people (and those with dysphagia) do not drink adequate amounts of water, the average adult needs to drink around 1.5-2litres of liquids a day, but may require more depending on levels of physical activity (7).
Drinking enough fluid can assist in preventing or treating the following ailments:
- Pressure ulcers
- Urinary infections and incontinence
- Heart disease
- Diabetes management
- Dizziness and confusion leading to falls
- Skin conditions
- Kidney stones
- Low blood pressure
- Cognitive impairment
- Poor oral health
Hydration and Dysphagia
One way of helping patients with swallowing problems to take fluids without aspirating is to consume liquid of a thicker consistency. A speech and language therapist can give advice about thickened fluids, as they may not always be indicated and in some cases make swallowing more difficult. Fluid can be thickened artificially with powder or bought pre-thickened.
There is an internationally agreed grading scale for food and liquids which is shown here (9):
The position in which you drink can also affect swallowing. One study by Young et al (10), showed that drinking with a chin-down posture (also known as a ‘chin tuck’) can “be beneficial for individuals with delayed onset of laryngeal vestibule closure and reduced duration of the laryngeal vestibule closure”. This is important because we want the laryngeal vestibule to close in order to sufficiently protect our airway whilst swallowing.
A person with dysphagia may be advised to use a specialist drinking device by their speech and language therapist. Each device, like the person with dysphagia, is different. Therefore, it is important to seek specialist advice when considering options to support drinking, as not all devices may be indicated for all types of swallowing difficulty.
Drinking smaller quantities with each sip:
It is possible that limiting the amount of fluid consumed with each swallow can also make swallowing safer. (11) For example when recovering from a stroke people with dysphagia may be initially restricted to a 5cc teaspoonful of fluid. Drinking devices are available which restrict the volume of fluid delivered with each tip of the cup (eg. Drink-Rite®). Sometimes those with learning difficulties or dementia may gulp fluid too quickly, risking aspiration. A controlled flow drinking cup like Drink-Rite will help to minimise the risk of aspiration when drinking too quickly (see pages 8 and 9).
- RCSLT (2021). Dysphagia Overview. Royal College of Speech and Language Therapists, viewed 8 March 2021, <https://www.rcslt.org/speech-and-language-therapy/clinical-information/dysphagia/ >
- Peladic, N.J., Orlandoni, P., Dell’Aquila, G., Carrieri, B., Eusebi, P., Landi, F., Volpato, S., Zuliani, G., Lattanzio, F. and Cherubini, A. (2019). Dysphagia in nursing home residents: Management and outcomes. Journal of the American Medical Directors Association, 20(2), pp.147-151.
- Umemoto, G. and Furuya, H., (2020). Management of dysphagia in patients with Parkinson’s disease and related disorders. Internal Medicine, 59(1), pp.7-14.
- Holland, G., Jayasekeran, V., Pendleton, N., Horan, M., Jones, M. and Hamdy, S. (2011). Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Diseases of the Esophagus, 24(7), pp.476-480.
- O’Keeffe, S.T. (2018). Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified?. BMC geriatrics, 18(1), pp.1-10.
- NHS (2021). Dysphagia (Swallowing Problems). NHS, viewed 28 February 2021 <nhs.uk/conditions/Dysphagia>
- The Association of UK Dietitians. (2021). The Importance of Hydration. BDA, viewed 8 March 2021 <https://www.bda.uk.com/resource/the-importance-of-hydration.html>
- Ritz, P. and Berrut, G. (2005). The importance of good hydration for day-to-day health. Nutrition reviews, 63(suppl_1), pp.S6-S13.
- (2021). The IDDSI Framework. The International Dysphagia Diet Standardisation Initiative, viewed 8 March 2021 <https://iddsi.org/framework/>
- Young, J.L., Macrae, P., Anderson, C., Taylor-Kamara, I. and Humbert, I.A. (2015). The sequence of swallowing events during the chin-down posture. American journal of speech-language pathology, 24(4), pp.659-670.
- Rofes, L., Arreola, V., Almirall, J., Cabré, M., Campins, L., García-Peris, P., Speyer, R. and Clavé, P. (2010). Diagnosis and management of oropharyngeal dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterology research and practice, 2011.