The efficacy of pre-thickened fluids on total fluid and nutrient consumption among extended care residents requiring thickened fluids due to risk of aspiration.

SIR—Dysphagia is associated with many neurological and neuromuscular conditions including stroke and Parkinson’s disease. Consequently dysphagia is a common condition in our patient population. Treatment of dysphagia necessitates the use of thickened fluids, however there are problems with the use of thickener. Failure to achieve the recommended consistency can increase the risk of aspiration. Dysphagia patients who receive thickened fluids frequently fail to meet their fluid requirements [1] and this can lead to dehydration. Whelan [1] investigated fluid intake in 24 stroke patients with dysphagia to evaluate the effect of the disability, and identify the type of fluid given. The mean thickened fluid intake was 455 ml/day resulting in the use of an extra 742 ml/day of supplementary parenteral fluids. This still did not result in an adequate total intake. However, patients not on a specialist stroke unit who received pre-thickened fluids drank almost 100% more than those on powder-thickened fluids. In a small, unpublished study on 10 patients in St. Mary’s Hospital, fibre, fluid and laxative intake was assessed. In this study, the patients on thickened fluids had a lower total intake and their fluid intake consisted mainly of poor nutritional quality beverages such as tea and lemonade. The use of powder thickener added to fluids relies on the staff achieving the correct consistency through correct instruction and adequate guidelines. Poor hydration can adversely affect a number of physiological processes including the regulation of body temperature, the distribution of nutrients and the excretion and elimination of waste products of metabolism. A study conducted on a non-specialist stroke unit who received pre-thickened drinks consumed almost 100% more than those on powderthickened fluids [1]. We conducted a small study at St. Mary’s Hospital in Dublin on 11 patients to assess whether the use of pre-thickened, standardised consistency fluids resulted in an increase in fluid and nutrient intake, reduced constipation rates and improved hydration status in dysphagic patients.