Clinician's Library

Improving the Nutritional Intake of those with Dysphagia

27 April 2017

 

Dysphagia

Dysphagia is a secondary symptom of 127 conditions including stroke, mouth and throat cancer, Parkinson’s, Alzheimer’s and motor neurone disease. It affects all ages from birth but presents frequently in the over 50’s (approx. 8-10% world wide), equivalent to a global population of 560 million people. It can be defined as a disorder of swallowing mechanics resulting in impairment in the safety, efficiency or quality of eating and drinking. As a result, food and drink flow too fast for the patient to cope with and enter the lungs. If not identified, the patient will quickly develop aspiration pneumonia, which will lead to malnutrition, dehydration and admittance to hospital.

To prevent these complications a speech and language therapist will assess a patient’s swallowing ability and decide what foods and drinks are safe for them to swallow. Foods may have to be pureed and every drink must have their consistencies changed to make them thicker and slow their transit. Drinks must be changed to a Stage 1: Syrup consistency or Stage 2: Custard Consistency (RCSLT, 2007).

To change the consistency of fluids, thickener is added. Historically the only thickeners available were starch and gum based. Supplied in a large tin with a plastic scoop, one, two or three scoops are added until the desired consistency is achieved. Studies show traditional thickeners used in drinks are difficult to use. As a direct result less than 50% of patients had drinks at an appropriate consistency and they tend to be offered 50% less to drink (Whelan, 2001).

Difficulties associated with previous thickeners:
• Difficult to use
• Deciding on correct consistency is a subjective matter, not all carers’ perceptions are the same
• The number of scoops patients receive may vary
• Different drinks affect the thickeners ability to thicken; extending the time the thickener requires
• The thickener could start to separate from the drink after a short time.
• These situations make the drinks unpalatable, unsafe and unused by the patient

The Greater Manchester Academic Health Science Network (GM AHSN), and Manchester: Integrating Medicine and Innovative Technology (MIMIT) have been working together to address unmet healthcare needs. With funding from the GM AHSN Technology Innovation Challenge, Slõ Drinks have developed a new high calorie, nutrient rich milkshake mix, which when made with milk, reaches a perfect consistency to aid dysphagia sufferers in swallowing. Since receiving funding Slõ Drinks have been added to the Enteral Feeds Contracts for NHS England, Scotland and in March NHS Northern Ireland. They are also available to buy at www.slodrinks.com/uk/shop

Slõ Milkshakes+ are presented pre-prepared in a sachet. They contain a mixture of 25 essential vitamins and minerals, milk fats and crucially a cellulose thickener. This has excellent bonding qualities with whole milk and hydrates quickly. Added at an inclusion volume accurate to 0.01g, Slõ Milkshakes+ quickly achieve the correct consistency. Importantly, they maintain consistency for 24 hours (when kept in the fridge) allowing the drinker to consume small amounts at a time. This thickener is also amylase resistant, dissolves completely and is tasteless so the drinker can only taste the milkshake. Slõ Milkshakes+ do not taste as sweet as pre-made alternatives; ultimately this should improve compliance encouraging people to drink more, more frequently.

Preparing a Slõ Milkshake+ reliably to Stage 1 or Stage 2 consistency is therefore
as quick and easy as an ordinary supplement, but it will be safer for the drinker to swallow allowing them to consume 330+ calories, including 23g+ of protein, and a mix of vitamins and minerals.

The Future

The long term trend is for the incidence of dysphagia to increase. Its effect on quality of life from treating the primary condition and impact on a patient’s physical and mental wellbeing is now widely acknowledged. It is therefore essential that more cost effective, reliable and easy to use products to supplement a dysphagia patient’s oral nutritional intake are brought to market. Slõ Drinks are in the final stages of creating a Slõ Vanilla Milkshake+. Longer term the company aims to supplement dysphagia patients’ vitamin and mineral intake by providing Slõ Multi Vitamins and Slõ Multi Minerals.

This article originally appeared in the Iinnov-age magazine  published by Edward Health Care. You can download a pdf copy of the magazine here

References:

Whelan K. (2001). Inadequate fluid intakes in dysphagic acute stroke. Clinical Nutrition. 20(5); 423-428.

ROYAL COLLEGE OF SPEECH AND LANGUAGE THERAPISTS, 2007. Policy statement: The specialist contribution of speech and language therapists along the care pathway for stroke survivors. Available at: http://www.stroke-in-stoke.info/otherfiles/policynov07.pdf [Accessed: 2nd March 2017]

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