Dysphagia Research Summaries:
The following studies reveal that use of modified diets and/or poor anterior tongue-palate pressure may lead to dehydration and malnutrition in aging adults.
O’Keefe, S.T. (2018). Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified? BMC Geriatrics, 18(1),167. https://doi.org/10.1186/s12877-018-0839-7
There are minimal randomized control trials (RCTs) to support the use of thickening liquids and none for texture modified foods to reduce aspiration pneumonia. There is also evidence of the following:
- Use of thickened liquids can increase the risk of dehydration and urinary tract infections.
- Modified diets can contribute to malnutrition due to poorer intake, with pureed diets resulting in reduced calories, micronutrients, and protein when compared to regular diets.
- Increased costs and patient dissatisfaction with modified diets and liquids.
Conversely, there is reasonable evidence, including a large RCT, which supports early behavioral interventions with SLPs reducing the risk of aspiration pneumonia. A patient should be involved in the decision-making process for selection and consent of his or her diet only after being informed of possible benefits and risks, including impact to quality of life.
Namasivayam, A. M., Steele, C. M., & Keller, H. (2016). The effect of tongue strength on meal consumption in long term care. Clinical Nutrition. http://dx.doi.org/10.1016/j.clnu.2015.08.001
Tongue pressure assessment may be a beneficial tool to evaluate risk of malnutrition in the LTC population. Anterior tongue-palate pressures were measured using the Iowa Oral Performance Instrument (IOPI) for LTC residents. Each resident was observed during three meals to record the length of time to consume meal, the amount consumed, as well as overt signs of swallowing difficulty. Results indicated residents with lower tongue strength exhibited longer meal times, reduced food consumption, and increased overt signs of swallowing difficulty.
Synchrony Dysphagia Solutions by ACP® with OmnisEMG Biofeedback used in conjunction with evidenced-based exercise can improve tongue strength and swallow function.