Most residential aged care facilities (RACFs) have a relatively large stock of thickened fluids. With approximately 68% of residents having dysphagia, many resident require thickened fluids to maintain their pulmonary health. Some sites prefer to use fluids that are pre-thickened, which generally improves the accuracy of the thickness the resident receives.  However the majority of RACFs will have some form of thickening powder on-site. This allows any drink to be made to any of the 3 thickness levels (mildly, moderately or extremely thick).

It is important to note that there are a few different products on the market and these products are all unique. A recipe guide will accompany each product, and this should be followed specifically. Some will require the powder to be added to the glass before the fluids, and some require the powder to be stirred into a funnel in the fluids. These powders will take different amounts of stirring and standing times to thicken which is important to consider.

There is also one very important piece of equipment that will accompany the powder – the scoop!

It is extremely important to use the specific scoop that is provided with the product to ensure accurate thickening. Different products have different sized scoops and these DO NOT equal a standard teaspoon. Many times, it has been found that residents are provided with under or over thickened drinks because the proper scoop was not used to make the fluids. Equally important is the amount of fluids that the recipe requires. It is often found that staff know that 1 scoop = a mildly thick fluid, however they are unaware of the amount of fluid that is required to obtain the desired consistency. Again, each product is different and it is essential that the correct amount of fluids is used, as per the recipe.

If in doubt, add more thickener right? Increasing the thickness of a resident’s drink without clinical recommendations from your speech pathologist can lead to adverse outcomes:

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1. Dehydration – not because thickened fluids are any less hydrating than regular fluids, but generally because people tend to drink less of them.
2. Aspiration – there are many reasons that people aspirate. One reason can be the residue left if the pharynx following a swallow. Providing extra thickness when it is not indicated, can increase pharyngeal residue and subsequently, the chance of aspiration in some residents.
3. Choking – fluids that are too thick can block the airway and cause choking episodes.

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Thickness levels are NOT interchangeable and should only be changed on the advice of a speech pathologist. A resident on mildly thick fluids should not be given moderately thick fluids. A resident on moderately thick fluids should not be given extremely thick fluids. A resident on extremely thick fluids should not be given ‘fluid’ that can hold up a spoon, unsupported. There is such a thing as fluids that are too thick, and as stated above, this can lead to adverse outcomes for the resident.

In short, use the recipe guide and the scoop(s) provided in your products. And if in doubt – call your speech pathologist.