The importance of hydration in dysphagia management

Written by Caroline Hill, dietitian for Dysphagia Kitchen

Now that the warmer weather is finally upon us, I thought it was a pertinent time to remind everyone about the importance of hydration.

Hydration is just as important as ensuring adequate nutrition and even more so for people living with dysphagia.  The risk of dehydration in people with dysphagia has been found to be range from 44 to 75%1.

Dehydration occurs due to the body losing more fluid than it is taking in and can lead to the following consequences:

  • Constipation
  • Urinary tract infections
  • Confusion
  • Drowsiness
  • Falls

The signs of dehydration include:

  • Feeling thirsty
  • Dark yellow and strong-smelling urine
  • Feeling dizzy or lightheaded
  • Feeling tired
  • A dry mouth, lips or eyes

Why are people with dysphagia at increased risk of dehydration?

One of the strategies of dysphagia management is the use of thickened fluids.  Altering the consistency of a fluid can in some cases make it more challenging for the person with dysphagia to receive adequate hydration.  This can be for a number of reasons including the chosen thickening agent which may unfavourably alter the appearance and taste of the drink, early fatigue with swallowing leading to reduced food and intake and reliance of support from others with safe consumption of fluids.

How can dehydration be managed in people with dysphagia?

There are a number of factors that be considered to help ensure someone with dysphagia can achieve an adequate fluid intake, these include:

  1. Thickener choice
  2. Cognition challenges
  3. Physical barriers

Choice of thickener

Thickened drinks are used to alter the flow rate of a liquid allowing more time for the person with dysphagia to swallow the drink safely.  The level of thickened fluid required will be determined following a speech and language therapy assessment.  Not only may the thickness of the drink change but the amount recommended may also be limited.  As a dietitian both these factors are particularly important, especially if oral nutritional supplements are being considered.

It is important that the thickener chosen to alter the consistency of the drink to improve the safety of the drink for the person with dysphagia has the following features:

  • does not alter the taste of the drink to be thickened
  • does not alter the appearance of the drink to be thickened i.e. no change in colour or clarity of the drink
  • can be safely used across a variety of different drinks to increase patient choice.

All of these features will aid improve compliance with thickened fluids.  It is important to work with the person with dysphagia to implement a care plan that is person centred, whilst balancing risk of aspiration with quality of life.

Cognitive challenges

Communication difficulties that arise due to medical conditions that are common among people with dysphagia include stroke, dementia and brain injury.  These communication challenges may make it difficult for the person with dysphagia to express the need for help with a drink, give a preference over drink choice or indicate they are thirsty.

Physical barriers

Dysphagia that has been diagnosed due to conditions such as stroke, brain injury and head and neck cancers, may also pose physical challenges.  These include requiring assistance to drink, unable to prepare and serve their own drinks and changes to fluid thickness and volume.  These factors may limit a person’s overall fluid intake resulting in dehydration.

Overcoming all these factors are an important consideration in dysphagia management to ensure those people with dysphagia receive adequate hydration.

Tops Tips for improving hydration for people with dysphagia

  1. Offer a variety of different fluids in line with the IDDSI level recommended by the SLT.
  2. Offer drinks on a regular basis.
  3. Support them to have their drinks safely.
  4. Liquids can also be provided through food such as soup and yoghurts – remember that these must meet the IDDSI food level recommended by the SLT.
  5. Don’t forget about the importance of oral care.

References:

1. Reber E, Gomes F, Dähn IA, Vasiloglou MF, Stanga Z. Management of Dehydration in Patients Suffering Swallowing Difficulties. J Clin Med. 2019;8(11):1923. Published 2019 Nov 8. doi:10.3390/jcm8111923

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