Thickener for swallowing difficulties

Thickener can be helpful for people with swallowing problems (dysphagia) and may be recommended by a speech and language therapist (SLT) to improve swallowing safety.

However, recently thickener has been used more often to manage swallowing issues, sometimes without a full assessment by an SLT. Research has shown that using thickener may actually increase the risk of chest problems, and that swallowing thin liquids may be less risky than previously thought.

Does my patient need thickener?

What to consider first:

• Have they been assessed by speech and language therapy previously? If so, were recommendations made?
• Is the person positioned upright for all food and drink?
• Do they sit comfortably in their dining chair? For example, not leaning back, feet resting on the floor
• Is the person fully supported by their carer? If not, this may be beneficial
• Do they use a spouted beaker? Open cup is preferable to a straw or spouted beaker where possible
• Does fluid pour from their mouth when drinking? Thicker fluids may be useful to control the fluid
• Are they coughing with every drink they have and only with drinks? thickener could be useful

A cough is not necessarily bad, it indicates airway protection and sensation around the airway.

When thickener is not needed:

• Struggling with food: Thickener won’t help with food issues; it’s not meant for that.
• Struggling with saliva or secretion control: Thickener won’t help here either. Consider medications to reduce saliva, like hyoscine, and get advice from the Respiratory team.
• Coughing all the time, not just when eating or drinking: This could be caused by reflux. Use the reflux symptom index to help assess and try treatments.
• Have a respiratory condition (like COPD, severe asthma, or emphysema): Thickened fluids take more effort to swallow, which can make breathing and swallowing even harder.

The importance of oral hygiene

Good oral hygiene is key to preventing aspiration pneumonia. Research shows that for aspiration pneumonia to happen, there needs to be poor health, bad oral hygiene, and swallowing problems (dysphagia).

If a person maintains good health and oral hygiene, the risk of developing aspiration pneumonia from swallowing issues is lower, though it can’t be completely avoided, even with thickener.

Things to consider with swallowing difficulties:

1. Thickener used inappropriately can increase the risk of chest complications, aspirating thickened fluids is worse than aspirating normal fluids
2. Aspirating thickened fluids is more likely to cause chest infection than aspirating normal fluids
3. Thickener can make swallowing more effortful, causing fatigue and increasing the risk of aspiration
4. Ensure all thickener is prescribed with a specific dosage according to each manufacturers guidelines, without dosage there will be inconsistency which affects safety but also patient experience
5. Cough is good: Cough indicates airway sensation and protection
6. Thickener can reduce distress from excessive coughing when drinking

Top tips for prescribing thickener

• Resource thicken up clear is the preferred thickener in Leeds
• Other thickeners have a different dosage and interact differently in fluid.
• Always provide a dosage for the patient so that carers have guidance to follow, usually start with a low dosage to begin with (for example, level 1)
• Other considerations: Any evidence of dry mouth, oral thrush, reflux, respiratory disorders?
• Supplement drinks can be prescribed in a pre-thickened consistency

Different thickeners have different dosage.

Contact the Speech and Swallowing team for queries and clinical discussion around swallowing concerns on the care home advice line.

Thickening fluids

How to prepare thickened fluids with resource thicken up clear

• Step 1: Accurately measure 200mls of a drink made to your taste (for example, with milk, sugar or cordial), ideally in a measuring jug.
• Step 2: Take a clean dry cup, glass or beaker and put the stated number of flat scoops of thicken up clear in first.
• Step 3: Pour the drink over the powder.
• Step 4: Start stirring with a spoon immediately until the powder is dissolved.
• Step 5: Leave to stand for one minute (for water, tea and coffee) or a few minutes (for juices and milk) until the powder is dissolved.

Top tips:

• If you need to thicken drinks in advance, check the consistency is correct before serving. your speech and language therapist can discuss this in more detail.
• If your resident has nutritional supplements the method for thickening these is slightly different. Please ask your speech and language therapist for further advice.