Episode 335: 334. Do Thicken Liquids Prevent Dysphagia?

Oropharyngeal dysphagia is highly prevalent in hospitalized patients with Alzheimer disease or other dementias. These patients often are prescribed thick liquid diets

Makhnevich A et al. Thick liquids and clinical outcomes in hospitalized patients with Alzheimer disease and related dementias and dysphagia. JAMA Intern Med 2024 May 6; [e-pub].

Researchers conducted a retrospective propensity-matched analysis, ≈4500 patients with Alzheimer disease or other dementias who were hospitalized with clinical concern for dysphagia and received thick liquid diets and matched to ≈4500 patients who had received thin liquid diets.

Hospital mortality was similar in the two groups. Compared with patients who received thin liquids, those who received thick liquids were significantly less likely to be intubated (odds ratio, 0.7) but were significantly more likely to have respiratory complications, including pneumonia (OR, 1.7)

In this end you are preventing intubation by 30 percent but causing pna by 70% --- neither are good and neither is a clear winner

Rant on ‘what we know to be true’ and measure it

This large study supports a hypothesis that thick liquids minimize the volume of aspiration, which explains the decrease in intubations. However, thick liquids also are more difficult to clear from the airway when aspiration occurs, leading to more respiratory complications.