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How do you thicken drinks for the elderly?

5 min read

Dysphagia, or difficulty swallowing, is a condition affecting a significant portion of the aging population. Learning how do you thicken drinks for the elderly is a critical step in managing this condition and preventing serious health complications like aspiration pneumonia.

Quick Summary

Thickening drinks for seniors involves adding commercial thickeners or natural agents like baby cereal and pureed fruit to control consistency, making liquids safer to swallow. The specific texture level required for an individual with dysphagia should always be determined by a qualified healthcare professional, such as a speech-language pathologist, to ensure safety and proper hydration.

Key Points

  • Thickener Options: Use commercial starch-based or gum-based powders and gels, or natural alternatives like baby rice cereal and pureed fruit.

  • Professional Guidance is Key: Always consult a speech-language pathologist (SLP) to determine the safest and most appropriate liquid thickness level for the individual.

  • Standardized Consistency: Follow the International Dysphagia Diet Standardisation Initiative (IDDSI) framework to ensure consistent thickness for all liquids served.

  • Proper Mixing Technique: Add thickener powder to a dry cup before adding liquid and stir vigorously to prevent lumps, and allow time for thickening.

  • Hydration Strategies: Address potential dehydration by offering smaller, more frequent drinks and incorporating high-fluid foods like pureed fruits and yogurt.

  • Address Palatability: Counteract any unpleasant taste or texture by trying different types of thickeners and offering a variety of flavors and beverages.

In This Article

Understanding Dysphagia and the Need for Thickened Liquids

Dysphagia is a medical term for difficulty or discomfort in swallowing. It's a common issue among the elderly, often stemming from conditions like stroke, Parkinson’s disease, or dementia. The primary risk associated with dysphagia and thin liquids is aspiration, where fluid enters the lungs instead of the stomach. This can lead to aspiration pneumonia, a serious and potentially life-threatening lung infection. By increasing a liquid's viscosity, or thickness, the flow rate is slowed, giving the individual more time to safely manage the liquid in their mouth and throat.

Identifying When Thickening Is Necessary

Symptoms that may indicate a need for thickened liquids include coughing or choking during or after drinking, a gurgly or wet-sounding voice, and unexplained weight loss or dehydration. A formal evaluation by a speech-language pathologist (SLP) is the best way to determine the correct and safest course of action. An SLP can recommend the appropriate liquid thickness and provide guidance on other swallowing strategies.

Commercial Thickeners vs. Natural Alternatives

Caregivers have two primary options for thickening drinks for the elderly: commercial thickeners and natural, whole-food alternatives. Both have distinct advantages and potential drawbacks.

Commercial Thickeners

Commercial thickeners are powders or gels designed specifically for modifying liquid consistency. They are often flavorless, odorless, and come in pre-measured packets or canisters. These products provide a precise and consistent result, making them a popular choice for clinical settings and home care.

Common types of commercial thickeners:

  • Starch-based thickeners: These typically contain modified cornstarch and are widely available. A key consideration is that they can continue to thicken over time, so drinks should be monitored. Some individuals report a slight grainy or chalky texture.
  • Gum-based thickeners: Using ingredients like xanthan gum, these thickeners offer a clearer appearance and maintain a stable consistency over time. They often require more vigorous mixing to prevent clumping but are known for a smoother mouthfeel.

Natural Food Thickeners

For those seeking alternatives or simply looking to add variety, several natural food items can be used to increase liquid thickness. These can also add nutritional value, which is important for seniors who may have low appetite.

Examples of natural thickeners:

  • Baby rice cereal: A classic thickener for milk-based beverages, baby rice cereal is easy to find and can be added a spoonful at a time until the desired consistency is reached.
  • Pureed fruits or vegetables: Blending soft fruits like bananas, peaches, or applesauce into juices or smoothies can naturally thicken them. This also adds valuable fiber and vitamins.
  • Instant potato flakes: Can be used to thicken savory liquids like broths and soups.
  • Gelatin powder: Plain gelatin can be used for cold liquids, though it is important to remember it will set completely if cooled for too long.

The International Dysphagia Diet Standardisation Initiative (IDDSI)

The IDDSI framework provides a standardized system for classifying thickened liquids and texture-modified foods. This helps ensure that patients receive the correct level of thickness wherever they are. The IDDSI defines levels based on liquid viscosity, from thin to extremely thick.

Key IDDSI levels for liquids:

  • Level 1: Slightly Thick: Like a fruit nectar, this can be drunk from a cup. It is thicker than water but flows easily.
  • Level 2: Mildly Thick: This is similar to a milkshake and requires more effort to drink. It drips slowly off a spoon.
  • Level 3: Moderately Thick: This consistency is like honey and must typically be eaten with a spoon.

Following the specific IDDSI level recommended by an SLP is crucial for patient safety. The wrong consistency can be just as dangerous as not thickening at all.

Step-by-Step Guide to Thickening Drinks

Preparing thickened drinks consistently is vital. Here are some general tips, though you should always follow the specific instructions on any commercial thickener product.

  1. Start with the right tools. A whisk or a shaker bottle can help prevent clumps, especially with powdered thickeners.
  2. Measure accurately. Use the scoop provided with the commercial thickener or measure natural ingredients carefully. Consistency is key.
  3. Add thickener first. For powders, adding the powder to the dry cup before pouring in the liquid can help prevent lumps. Stir vigorously for about 20 seconds.
  4. Allow time to set. Starch-based thickeners need time to reach their final consistency, typically 1–5 minutes. Gum-based thickeners thicken almost instantly.
  5. Check the consistency. Use a spoon or the IDDSI flow test to ensure the liquid has reached the correct thickness before serving. Do not serve a liquid that is too thin or too thick.
  6. Adjust as needed. If the liquid is too thin, add a small amount of extra thickener. If it's too thick, add a bit more of the original thin liquid. It's often safer to start with less thickener and add more slowly.

Common Challenges and Solutions

Challenge Description Solution
Taste/Palatability Thickened liquids may alter the natural flavor, leading to low fluid intake. Offer a variety of thickened beverages, including favorites. Experiment with gum-based thickeners, which tend to have a cleaner taste than starch-based ones.
Inconsistency The liquid's thickness can change over time due to temperature or the thickener type. Use a gum-based thickener for stable viscosity. If using a starch-based one, prepare and serve immediately. Always re-check consistency before each use.
Dehydration Seniors may drink less because of the altered taste, texture, and feeling of early fullness. Encourage smaller, more frequent sips. Incorporate high-fluid-content pureed foods like yogurt and soup. Ensure thickened water is readily available.
Lumps Poor mixing can result in unpleasant, lumpy drinks. Use a shaker bottle or a whisk to ensure the powder is fully dissolved. Add the powder first before pouring in the liquid.
Medication Issues Thickening can affect how medications are absorbed. Consult a pharmacist or doctor before mixing medication with thickened liquids. They may recommend alternative administration methods.

Seeking Professional Guidance

While this guide provides helpful information, it is not a substitute for professional medical advice. If you suspect an elderly loved one has swallowing difficulties, consulting a speech-language pathologist and their primary care physician is the most important step.

For more information on dysphagia management and research, the American Speech-Language-Hearing Association is an excellent resource: https://www.asha.org/practice/guidelines/Dysphagia-Practice-Guidelines/

Conclusion

Mastering how to thicken drinks for the elderly is a crucial skill for caregivers dealing with dysphagia. By understanding the types of thickeners available, following standardized guidelines like IDDSI, and working closely with healthcare professionals, you can ensure that your loved one stays safe, hydrated, and nourished. Careful preparation and attention to individual preferences can help make thickened liquids a safe and manageable part of their daily routine.

Frequently Asked Questions

Dysphagia is the medical term for difficulty swallowing, which is common in older adults. It can be caused by various health issues and increases the risk of liquids entering the lungs, which can cause aspiration pneumonia.

Yes, commercial thickeners are generally considered safe for adults. However, it is essential to use them correctly according to the instructions and the prescribed thickness level from a healthcare professional, like a speech-language pathologist.

While cornstarch is a natural thickener, commercial thickeners are often more reliable and consistent for managing dysphagia. They are specifically formulated to maintain consistency over time and in various liquids. You should consult an SLP before using household ingredients for safety.

Some starch-based thickeners can break down in saliva, causing the liquid to thin out over time. This is known as amylase breakdown. Gum-based thickeners are typically more resistant to this effect and maintain a stable consistency.

To improve palatability, try different types of thickeners, as some have a more pleasant taste and texture. You can also thicken a variety of beverages, such as smoothies or soups, and use natural thickeners like pureed fruits to enhance flavor.

According to the IDDSI framework, nectar-thick liquids (Level 1) are easily pourable, similar to thicker cream soup. Honey-thick liquids (Level 2) are less pourable and drizzle slowly, like honey or a milkshake. The required level depends on the severity of the swallowing difficulty.

Refusal can lead to dehydration. Address the taste or texture concerns, try a different type of thickener or flavor, and offer smaller, more frequent servings. Incorporating high-fluid pureed foods can also help, but always prioritize professional consultation.

You should not mix medication into thickened liquids without professional guidance. The thickener can alter medication absorption rates. Always consult a pharmacist or doctor for the safest method of administration.

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.