If thickeners are prescribed for individuals (rather than by bulk prescribing) are they only used for the people, they are prescribed for? However, it is estimated that, at any one time, over 50% of people in care homes will have an impaired ability to eat or drink safely (Hanson, 2013). This is where the role of producers in supporting the use of their thickeners is so paramount. The NHS is currently developing The Dysphagia Game, a new game-based learning programme to help improve dysphagia care. Observation of the use of prescribed thickeners has highlighted variations in how they are used and in the terminology used to record individual required consistencies (McCormick et al, 2008). Directions How important do you think collaboration with industry is to the speech therapy profession? They may affect how medication works check with GP or pharmacist. A key element in reducing the risk of choking and aspiration when drinking is to modify the texture of the fluid consumed by people with dysphagia. Early identification of dysphagia is key, and SLTs will use a variety of different techniques to assess swallowing impairment, including bedside screening tools, physical assessment and videofluoroscopy (Steele et al. A series of three-hour training sessions were attended by key staff from each home - these were mainly head chefs, senior nurses and care staff with a keen interest in nutritional issues.

I first became familiar with food thickeners when my elderly Mom was hospitalized with aspiration pneumonia. We are able share your email address with third parties (such as Google, Facebook and Twitter) in order to send you promoted content which is tailored to your interests as outlined above. If people have swallowing difficulties, do you have guidance and care plans on how to administer oral medicines safely and effectively, for example crushing a tablet? Has a medicines review been carried out to make sure that medicines are necessary and can be taken safely? A further evaluation of starch-based and gum-based thickeners is being explored to confirm our findings. Share: You can copy and redistribute the material in any medium or format, Your email address will not be published. Nestl Health Science offers support to care homes, other community organisations and individuals with dysphagia, for example through face-to-face or digital safety briefings. Its really important that were working ever more closely together. While this treatment is effective, some seniors dislike the texture of thickened beverages. Medicines: information for adult social care services, For further advice, contact medicines.enquiries@cqc.org.uk, IDDSI: Complete IDDSI framework - Detailed definitions (PDF). In contrast, gum-based thickeners have been shown to be more stable and maintain their thickness due to their amylase-resistant properties. Research takes time and its companies like Nestl Health Science who can really help bring things along and say to the profession, Look, this is what we can deliver. I think it takes industry to innovate and take things forward, because most of the SLT profession work in the NHS. According to Ashford (2005), there are three pillars of pneumonia: health status, oral health status and swallow function. Below you can select how youd like us to interact with you and well keep you updated with our latest content. Are staff (including kitchen staff who prepare foods), trained on the use of thickeners, and on any food modifications required by individuals? Feel free to swap out strawberries for your favorite fruit. There are also different types of dysphagia, depending on which aspect of the swallowing process is affected, and this can result in a range of symptoms. Cooking a Low Sodium Oven Fried Chicken Recipe, Pureed Food For Adults With Dysphagia (Difficulty Swallowing), My Moms Death A Personal Account Of A Life Well Lived And Gently Died, How To Pack A Beach Bag For A Senior Citizen. Foley et al (2008) found that using a combination of texture-modified diet, thickened fluids and intensive support from speech and language therapists resulted in reduced risk of aspiration for the first seven days after a stroke. Overall, there is a role for thickener in managing dysphagia for patients in acute and community settings, whilst being used safely and effectively. The latter could even increase risk of malnutrition and dehydration if a patient avoids eating and drinking. This is something weve developed. Theres the trinity of industry, research and the profession on the ground as well, of course, as patient groups and patient feedback. If thickeners are used incorrectly, they can be unpalatable as well as unsafe. Results from the staff questionnaires showed that a gum-based thickener was clearer when mixed and easier to mix with fewer problems, and no lumping was reported (Table 1). The workshops were all well received. Forty Barchester Healthcare homes were asked to provide information about the number of people currently prescribed a thickener and what product this was. As care home manager Jemma Robinson explains, preparing thickened drinks incorrectly can be just as dangerous as not having the thickener at all. Thickeners come in different strengths; nectar or honey are two of the most common food or beverage thickeners. Such as: These can include, but are not limited to: Dysphagia is usually assessed and treated by Speech & Language Therapists. Thickeners, alongside other factors including positioning, use of different eating and drinking vessels, oral hygiene and the possible use of artificial hydration if clinically indicated can be a valuable tool in the treatment of dysphagia. Thickeners: The evidence for their appropriate use in dysphagia management Research OUTREACH. One approach often used by SLTs is the addition of thickening agents to normal fluids to make them more viscous, and therefore easier for patients to swallow. Emotional impacts Staff felt it was easy and quick to mix and instructions were easy to follow. She says, Thickener means that residents can take their usual fluids, it reduces the risk of aspiration which can cause complications, or it means they do not need to have any other interventions like IV fluids: they can live a normal life. It is not only nursing home residents whose lives are impacted; over half of head and neck cancer patients report reduced quality of life due to dysphagia (Garcia-Peris et al, 2007). How is it monitored? To coincide with World Continence Week in June, Nursing Times ran a series of five free webinars from 20 to 24 June. Sandra Robinson recommends thinking about the following values when considering the use of thickened fluids; firstly, the patients needs, wishes and preferences, and then how the patient will feel, function and survive if prescribed thickeners. We chose to work with Nutricia and developed a plan to introduce its gum-based thickener (Nutilis Clear). There is, though, also a chance they are silently inhaling fluid or food, a situation which could only be identified with special investigations such as a video fluoroscopy of the swallow action. As speech and language therapist Sandra Robinson points out, industry innovation can lead to direct patient benefits: the recent move towards using gum-based thickener rather than starch-based thickener was a really useful change for our patients, because it meant that the thickener looked nicer, had an improved taste, and was safer one of the most important aspects. All data was anonymous. Specialist nurses call for more awareness of heart failure, Dont miss your latest monthly issue of Nursing Times, Englands CNO backs free staff car parking and protection of nurse title, The journey from specialist dementia nurse to Admiral Nurse, Supporting student nursing attrition with digital tools, Online Global Health course launched by University of Winchester, NHS nurses in England to receive 1,400 pay increase for 2022-23, Reports that government planning 5% NHS pay award, Nurses need strong unions and nursing leaders more than ever, New online platform aims to help nurses challenge racism, There is a need for a nurse registration in older peoples care, Englands CNO calls for fresh focus on retaining staff, Patient education can challenge health inequalities, Green light for unsafe change to industrial action rules, Global increase in violence against nurses since pandemic, Student Mental Health and Counselling Manager, Nursing Opportunities at Cleveland Clinic Abu Dhabi, This content is for health professionals only, This article has been double-blind peer reviewed, All thickeners must be prescribed by a GP, Supplies must be maintained to ensure stocks do not run out, Always follow the recommendation of a speech and language therapist for the use of a thickener, Mix the correct amount of fluid with the recommended amount of thickener follow manufacturers instructions, Make sure you know how much fluid different containers hold, Consider a clear thickener as it may improve adherence and hydration status, Allow all thickened drinks to stand for the recommended time for each product do not add more thickener if the consistency does not look right immediately, Throw away lumpy, thickened drinks and start again, Some fluids thickened with starch-based products may become thinner over time due to the presence of saliva consider a clear gum-based thickener, Ensure the consistency is correct before giving to the individual. Do you know what? document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Enter your email address to subscribe to this blog and receive notifications of new posts by email. Where is the use of thickeners recorded? A care home provider evaluated the use of fluid thickeners to reduce these risks, and implemented an initiative to improve understanding of dysphagia among both care and catering staff. Reduce the risk of dehydration for people requiring thickened fluids; Train staff in the correct use of thickeners; Ensure that residents with dysphagia were receiving palatable fluids; Find out whether starch-based or gum-based products were preferred. Just as weve noticed that industry has moved on, lets also move on. Sandra Robinson agrees with this approach: Thickener can be really useful while a patient also follows therapy, diet adaptation, and undergoes some possible spontaneous recovery from something like stroke. This is crucial to changing the culture around the use of thickeners, ensuring that it is not seen as the easy option, but is delivered by qualified professionals who understand the influence that thickener can have on gastric emptying times and other variables. Its the whole point. Barchester Healthcare provides care for people living in more than 200 care homes, many of whom have a diagnosed swallowing difficulty. Below you can select how youd like us to interact with you and well keep you updated with our latest content. A care home company developed training and compared the use of thickeners. Although this was a small and non-scientific evaluation, the input from staff teams was consistent and professional. If individuals are using thickener, are hydration levels monitored? Multidisciplinary working is key, as is the use of a holistic approach which uses other strategies to improve health and well-being for dysphagic individuals. For those unfamiliar, aspiration pneumonia is caused when food goes down the wrong pipe.. Julie Cichero, co-chair of the IDDSI framework, reports that in the UK, the annual cost of chest infections requiring hospital admission with routine care is around 1.8 times more expensive than chest infections requiring hospital admission with treatment from a speech and language therapist (Cichero, 2019). In addition, there are clear benefits to using just one thickener within a local area, as this means that everyone is fully safety trained and competent with one particular product, removing the need for multiple pathways and safety briefings for different products. https://www.sasspllc.com/three-pillars-pneumonia/, https://doi.org/10.1016/j.clnu.2007.08.006, https://doi.org/10.1161/01.STR.0000177529.86868.8d, https://doi.org/10.1097/MOO.0000000000000622, https://doi.org/10.1097/00005537-200204000-00001, https://doi.org/10.1007/s00455-014-9578-x, https://doi.org/10.1007/s00455-018-09974-5, https://researchoutreach.org/articles/thickeners-the-evidence-for-their-appropriate-use-in-dysphagia-management/, Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, Consciousness and Quantum Mechanics wherein Plancks constant becomes a variable, Diversity, Equity, Inclusion & Sustainable Practice statement. https://doi.org/10.1001/archoto.2010.129. Citation: Penney B (2014) Use of fluid thickener to reduce dysphagia risk. Thick-It Clear Advantage Food & Beverage Thickener Powder Single Serve Packets (30/bx) (Nectar Consistency)^Thick & Easy Packets 6.5 g packets, Honey Min.Order is 1 CS ( 100 Each / Case; ) by Diamond Crystal BrandsThick & Easy Instant Food and Beverage Thickener, 8 OunceHormel Thick & Easy Instant Food Thickener, Nectar Consistency, 0.16 Ounce (Pack of 100)Thick & Easy Honey Thickener, 6.5 Gram 100 Case. Dysphagia can occur at any age, from premature babies, through to the elderly and those at the end of life.