4.3 Hydration and thickening drinks

Introduction

Water is vital for life and good hydration is essential for health.   Adults are recommended to drink 2-2.5 litres of water each day (EFSA 2010).  Swallowing problems may compromise good hydration.

Individuals with swallowing problems should be offered drinks from a normal open cup unless advised by a speech and language therapist.

Drinking from a spouted beaker can increase the risk of drinks going down the wrong way because you have to tilt your head back and the fluid can shoot to the back of the throat before you are ready to swallow. They can also be undignified.  A spouted beaker may be appropriate for some people with movement disorders or lip weakness, but always ask the advice of a speech and language therapist before using one. 

This section contains resources about thickening liquids to the right consistency and equipment to help with drinking.  As such, this information is likely to be of interest to:

  • Staff working in health and social care
  • Trainers delivering sessions about dysphagia
  • People with swallowing problems and their families and friends
  • Students studying health and social care.

Consult your speech and language therapist, nurse or occupational therapist for advice about consistencies and adapted utensils.   

Why do drinks need to be thickened?

Normal drinks move quickly in the mouth and throat. Thickener makes fluids heavier, which slows them down giving the person more time to control the fluids.  Thickened fluids are less likely to get caught in the little pockets in the throat. This helps prevent the drink ‘going down the wrong way’ and being aspirated into the lungs.

A patient will be recommended thickened fluids following assessment by a speech and language therapist or a dysphagia trained practitioner.      

What are the UK national descriptors?

There are three groups of thickened fluid. These are:

·         Stage *1 (Coating)

·         Stage *2 (Thick drinking)

·         Stage *3 (Spooning) 

A definition for each consistency and examples of drinks can be found on the Swallowing status: Drinking Consistency sheets. See separate charts for Stage 1, Stage 2 and Stage 3). There is also a Drinking Consistency sheet for Naturally Thick Fluid.  

The National descriptors are also in the Sheffield Teaching Hospitals NHS Foundation Trust Thickened Fluids patient information leaflets. There is leaflet for Stage 1, Stage 2 and Stage 3. These contain practical tips on how to prepare drinks. 

There is also a resource sheet on How to make thickened drinks more appealing




 


What drinks should be thickened?

Thickener should be added to ALL drinks.   This means:

  • hot, cold, alcoholic and fizzy drinks  
  • thin gravy and thin soup 

Some drinks are naturally thick e.g. fruit smoothies, yoghurt drinks, syrupy fruit juices and milkshakes.

There are some ready-to-drink, pre thickened drinks. These drinks will usually be obtained on prescription from, or purchased at a pharmacy.  However, this is likely to be at the discretion of the pharmacist as to whether they will dispense the thickener.  This is because they will be responsible for the medical supervision of the product. 

Resources about hydration

Royal College of Nursing and National Patient Safety Agency (2007) Hospital hydration best practice toolkit.  Available here

Resources about thickening drinks 

There is a Easier swallowing: fluid thickening guide on the Nutrition and Diet Resources UK website, see link

There is a 3 minute video about how to thicken drinks on the Stroke4Carers website, see link

There is a video on the Dysphagia Recipes website about how to thicken drinks to the different consistencies, see link 

See our information sheets about the United Kingdom three national descriptors; how to make thickened drinks more appealing and the Easy Eating Nourishing Drinks: tips and recipe ideas and Soups.

Resources about eating and drinking equipment

The Disabled Living Foundation is a UK charity that provides impartial advice, information and training about independent living, see here    Their Living Made Easy website has a section about eating and drinking equipment, see link

The Stroke4Carers website has a section about cutlery and crockery to assist with eating and drinking, see here.

One-way valve straws, also known as Pat Saunders straws have one-way valves which stay filled with fluid even after removing the straw from your lips.   See Living Made Easy here.

A spouted beaker is available with a controlled metered flow, which avoids the need to tilt the head back.  This may be beneficial for those patients with reduced lip seal or movement disorders who may struggle to drink from an open cup. See. link.    

There are other special cups designed for people with swallowing problems.  If you put dysphagia cups into a search engine such as Google, you will find different designs and retailers.

Reference

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA), EFSA Journal 2010; 8(3):1459