Dysphagia and thickeners

Dysphagia is the medical term for difficulty swallowing.

Dysphagia can occur in either the:

• oral stage of swallowing (in the mouth)
• pharyngeal stage of swallowing (in the throat)
• oesophageal stage of swallowing (in the tube leading to the stomach)
• or in any combination of these.

Dysphagia can happen in people at any age, from premature babies, to older people and those at the end of life. Problems may arise as a result of:

• dementia
• stroke
• Parkinson’s disease
• head and neck cancers
• motor neurone disease
• brain injury
• learning disabilities.

People may have difficulties with a range of actions required for eating and drinking safely and efficiently. This may include:

• preparing food or drink in their mouth
• moving it backwards for swallowing
• triggering a swallow
• clearing food or fluid after swallowing.

Symptoms and complications

Some examples of these can include:

• coughing
• hoarseness
• discomfort or pain
• inability to control food or saliva (drooling)
• weight loss
• dehydration
• malnutrition
• chest infections
• aspiration pneumonia
• choking
• aversion to eating or drinking
• death.

Treatment for dysphagia

Dysphagia is usually assessed and treated by speech and language therapists. Treatment may include:

• exercises to help improve the efficiency of the swallow
• strategies to follow when eating and drinking to improve safety and/or comfort
• advice about:
  • posture and positioning
  • the rate of presentation of food or liquid
  • the time between bites and swallows
  • how the environment might help at meal and drink times (for example, fewer distractions)
  • how others might be able to help at meal and drink times
  • modifying the texture of food.

Other people can also provide help for people with dysphagia, for example:

• physiotherapists for advice about posture, positioning and chest care
• occupational therapists for advice about aids, adaptations and utensils at mealtimes
• dietitians for advice about nutritional intake
• psychologists for advice about distress at mealtimes.

It is important to always follow the advice from clinicians for people with dysphagia.

The Francis Report highlighted the importance of giving people food and fluid in a form they can safely consume. It forms part of NICE Guideline NG128.

Things to consider 

• Have all people who have dysphagia had an appropriate assessment or been referred for assessment?
• Have you carried out a medicines review to make sure that medicines are necessary and can be taken safely?
• If people have swallowing difficulties, do you have guidance and care plans on how to administer oral medicines safely and effectively, for example crushing a tablet or mixing medicines with food?
• Care plans for dysphagia should include:
  • current consistency recommendations
  • directions and risk assessments
  • when to seek further support.
• If thickeners are prescribed for a person (rather than by bulk prescribing or direct supply), are they only used for the person they are prescribed for?
• Are thickeners stored safely in an area that has been risk assessed? Incidents have been reported where a person has been harmed by accidentally swallowing thickening powders. For more information, see Patient Safety Alert on thickening powders.
• Are staff (including kitchen staff who prepare foods), trained on the use of thickeners, and on any food modifications that people may need?
• Where do you record the use of thickeners and how is it monitored?
• If a person is using thickener, are hydration levels monitored?
• Do staff know how to spot warning signs? For example:
  • difficulties and discomfort at meal or drinks time
  • dehydration
  • weight loss
  • chest infections.
• It’s important to follow advice in Drug Safety Update 27 April 2021. Avoid directly mixing together polyethylene glycol (PEG) laxatives (for example, macrogol powder) and starch-based thickeners.