27 March 2023
Within the profession, there has been growing interest in how thickened fluids are used in the management of clients who have difficulty swallowing liquids. We established a working group with members to look at the use of thickened fluids in the management of clients with eating, drinking, and swallowing difficulties (EDS).
A position statement has now been developed and is available to read below:
Within the UK, Speech and Language Therapists (SLTs) are recognised as the professionals most likely to lead on the assessment and management of eating, drinking and swallowing difficulties (dysphagia). A group of expert SLTs have developed the following statement to clarify the RCSLT’s position on the use of thickened fluids in the management of people with dysphagia. Other dysphagia-trained clinical practitioners may also find it useful to refer to this statement to inform their practice.
The long-standing practice of using commercially and naturally thick fluids is among the most common treatment tools in the management of eating, drinking and swallowing problems. The RCSLT acknowledges that this practice is undergoing increasing scrutiny.
The commonly accepted view is that by flowing more slowly, thickened fluids improve bolus containment and reduce risk of aspiration and cough-related distress, thereby improving safety and comfort. The literature reports that thickened fluids can alter swallow physiology and reduce aspiration. However, there is an absence of evidence that thickened fluids can reduce dysphagia-related complications such as respiratory tract infections, or that they improve health or quality of life outcomes for patients.
The evidence base to date reports a number of potential treatment burdens associated with this approach. These include: increased risk of dehydration and urinary tract infections, reduced health and social-related quality of life, early satiety, unpalatable taste and texture, increased thirst, altered bowel habits, increased risk of oral and pharyngeal residue, impaired bioavailability of certain medications, and increased risk of respiratory tract infections if thickened fluids are aspirated.
Patient-reported outcome studies generally indicate a preference against thickened fluids and highlight difficulties with adherence to thickened fluid recommendations.
Clinical practitioners have a responsibility to familiarise themselves with the current literature and explore within their workplaces how their use of thickened fluids aligns with the evidence base.
The RCSLT advises that decisions about thickened fluids, as for any intervention, should be made through a process of informed consent following a holistic assessment that includes consideration of the potential impact on health and quality of life. Patients or their proxies must understand what thickened fluid treatment entails, and its potential adverse side effects as well as its potential benefits.
The RCSLT also plans to publish a position paper on the evidence surrounding thickened fluids in clinical practice by the end of 2023.