Long-Term Care Survey Alert

These strategies may allow some residents to safely drink regular liquids.

Trend: "As a field, we are moving away from overprescribing thickened liquids and more and more looking at which people can safely stay on some thin liquids," says Nancy Swigert, MA, CCC-SLP, BRS-S, director of speech-language pathology and respiratory care at Central Baptist Hospital in Lexington, Ky.

Conundrum: "The tricky thing is we don't know which patient with dysphagia will get pneumonia and which one won't," says Swigert. "The medical team has to look at the whole picture and other risk factors to help the person/family make an informed consent about whether to have thickened liquids."

The risk factors, says Swigert, include the following:

• multiple medical diagnoses
• dependence for oral care
• being a current smoker
• the number of decayed teeth
• the number of medications the person takes

Also: "Some people cough so violently when they aspirate a little that they don't want to drink thin liquids."

Some patients can't safely drink thin liquids, Swigert says. But she thinks nursing facilities can enhance residents' quality of life a lot of times by having them drink thin liquids with designated staff supervising them and/or by using special techniques.

For example, you can provide liquids a teaspoon at a time, Swigert points out. Or staff can offer liquids in a cup that controls the "sip size." There are also straws that won't allow fluid to drop back down in the straw when you draw it up through the straw, she adds. You can "use a cut-out cup where you don't have to tip your head back to drink." Some residents will require supervision when they drink thin liquids, she notes.

Sidestep this problem: "Thickened liquids are not very palatable," cautions Swigert. "So if people don't drink enough of them, they may become poorly hydrated." Keep in mind that people find naturally thick liquids more appetizing -- examples include tomato juice, a yogurt drink, some nectars, and buttermilk, she adds.