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Meeting personal needs: hydration and nutrition
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Ensure specific advice from the multidisciplinary team (MDT) is followed regarding diet as appropriate; for example, puree diet/thickened fluids as recommended by the speech and language therapist (SLT). Many people with eating difficulties (like Miss West) need texture-modified food and fluids, for example, pureed/liquidised or thickened. Where food needs to be liquidised, each item should be liquidised separately to preserve distinctive flavours. The SLT may recommend thickened fluids to help to prevent the choking that can occur with liquid.
Questions for part A
Published in Henry J. Woodford, Essential Geriatrics, 2022
Which of the following statements is most accurate regarding the use of thickened fluids in older people with swallowing impairment?Liquid medications should be thickenedPharyngeal residues can be harder to clearThickened fluids help to reduce the aspiration of salivaThickened fluids improve quality of lifeThickened fluids reduce the risk of aspiration pneumonia by more than 50%
Enteral nutrition
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Not all patients needing nutritional support require tube feeding. This sounds obvious but, in practice, patients with oesophageal strictures are often referred for tube placement before any attempt has been made at liquid oral feeding. Likewise, patients with neurological dysphagia can often manage with thickened fluids. In such cases a supervised swallow, performed by a trained observer, is usually sufficient to confirm that oral feeding is safe, but a formal speech therapy assessment is helpful if there is uncertainty. A water-soluble contrast swallow using videofluoroscopy is useful for studying swallowing mechanisms in detail, but failure to demonstrate penetration of contrast into the trachea does not exclude the possibility of aspiration occurring at other times.
Managing the child born preterm after hospital discharge
Published in Speech, Language and Hearing, 2023
Katherine Sanchez, Alaina Martens, Emily Zimmerman
It is important to note that while thickening fluids is widely used to address pediatric dysphagia, some concerns have been raised about the use of thickened fluids with infants born preterm, as there have been some cases where the use of xanthan gum based thickeners have been linked to the development of necrotizing enterocolitis (Beal, Silverman, Bellant, Young, & Klontz, 2012). There are also concerns about the use of rice cereals as thickening agents in young infants born preterm, as this practice changes the caloric density of feeds (Dion, Duivestein, St Pierre, & Harris, 2015). Thus, in the preterm population, thickeners should be used with caution in the short-term, and only in consultation with medical and dietetic professionals (Gosa, Schooling, & Coleman, 2011).
Intake and Factors Associated with Consumption of Pureed Food in Long Term Care: An Analysis of Making the Most of Mealtimes (M3) Project
Published in Journal of Nutrition in Gerontology and Geriatrics, 2018
Vanessa Vucea, Heather H. Keller, Jill M. Morrison, Alison M. Duncan, Lisa M. Duizer, Christina O. Lengyel, Susan E. Slaughter
Assessment of residents at risk of dysphagia was based on a composite measure. All residents currently prescribed thickened fluids were categorized as at ‘dysphagia risk’. Those residents who could comply with a risk evaluation using the Screening Tool for Acute Neurological Dysphagia (STAND) assessment (i.e., water and applesauce swallowing test) (39, 48), and demonstrated challenges during the assessment, were classified as at risk. Finally, a subset of individuals who sometimes or often coughed and/or choked at any meal observation as part of M3 data collection, but were not already on thickened fluids and passed or did not complete the STAND, were also categorized as ‘at risk’ for dysphagia. Four dental hygienists, experienced in the care of older adults, (one per province) were trained together to complete a standardized oral health and dentition assessment of participants based on 13 items with sub-questions, each item pertaining to a specific aspect of oral health (39, 49). The assessment concluded with a subjective rating by the hygienist based on their standardized assessment; using a rating from 1 to 5, did the hygienist believe the oral health status could influence food intake of the participant (1 = not/unlikely influenced; 5 = food intake significantly impacted by oral health). This single item provides a practical variable to classify participants’ oral health status. In consultation with a member of the M3 team who is an oral health expert, this item was further categorized into two groups (0 or 1 vs. 2+) for the analysis.
Does the mandibular lingual release approach impact post-operative swallowing in patients with oral cavity and/or oropharyngeal squamous cell carcinomas: a scoping review
Published in Speech, Language and Hearing, 2023
N. M. Hardingham, E. C. Ward, N. A. Clayton, R. A. Gallagher
The fourth paper by Song et al. (2013) presented a retrospective cohort of MRLA (n = 15) and LSM (n = 7) patients (Table 3). The authors used the SAS to report swallowing outcomes 6 months post-surgery and reported no statistically significant difference in function between the two groups at that time (Note: no information was provided regarding how this was calculated, nor which statistical tests were performed). The mean data indicated that 73.3% (11/15) of MRLA participants had a satisfactory swallow (rated on the scale as good = a score of ≥9/15), compared to 57.1% (4/7) for the LSM group. This would appear to suggest a pattern (though non-significant) of better swallowing outcomes in the MRLA group, contrary to prior studies. When interpreting these findings, it is also critical to note that the sensitivity of the SAS to appropriately represent functional deficits is low and the scale itself is not validated. For example – a score of nine, which would be classified as ‘good/satisfactory’ on this scale, could be achieved if a participant was able to consume a meal within 15 min (5-points), however, this meal could comprise of small portions of food with tube feeding being the main means of nutrition (2-points) and having viscous fluids (2-points). Dependence on enteral feeding and thickened fluids would not be considered a ‘good or satisfactory’ swallowing outcome in other validated scales, such as the Functional Oral Intake Scale (Crary, Mann, & Groher, 2005) and as such the ability to interpret the swallowing findings from the Song paper is limited and is highly clinically relevant.