Position paper on the use of thickened fluids in the management of people with swallowing difficulties, Royal College of Speech and Language Therapists

Summary
●Thickened fluids are a well-known tool used in the management of eating, drinking and swallowing problems (dysphagia).
●Thickened fluids can reduce the risk of laryngeal penetration and aspiration.
●Some patients might prefer thickened fluids as they can improve oral control, fluid intake, or reduce distressing or unacceptable coughing when drinking.
●The overall evidence to date is unable to conclude definitively that thickened fluids can prevent or reduce dysphagia-related complications like aspiration pneumonia, dehydration or death, or that they can improve quality of life.
●Thickened fluids can lead to thirst, dehydration, reduced quality of life, impaired bioavailability of certain medications, altered bowel habits and increased risk of respiratory tract infections if aspirated.
●Studies reporting patients’ views generally indicate a preference against thickened fluids.
●The uncertainty created by the evidence does not mean that the practice should be abandoned. Decisions about thickened fluids should be carefully considered after comprehensive assessment and informed consent.
●In the event that a patient uses thickened fluids, a trial and ongoing review will allow for monitoring of any potential adverse effects and ascertain whether continued use is necessary.
●Rather than being used as a blanket approach or go-to treatment, thickened fluids are better considered as one of a number of dysphagia management tools.