Dysphagia, or difficulty swallowing, is a common condition among older adults, particularly those in senior living communities and hospital settings. Effective management of dysphagia is crucial to prevent serious health complications such as aspiration pneumonia, dehydration, and malnutrition. With the introduction of the International Dysphagia Diet Standardisation Initiative (IDDSI) framework, a new opportunity has arisen to optimize dysphagia care: Slightly Thick, Level 1 liquids.
While Slightly Thick, Level 1 liquids are relatively new in adult care, they offer a subtle increase in thickness compared to regular drinks, providing better control during swallowing while maintaining a natural drinking experience. This article explores the benefits of Slightly Thick, Level 1 liquids and their potential role in enhancing dysphagia management in adults.
Understanding IDDSI Slightly Thick, Level 1 Liquids
What Are Slightly Thick, Level 1 Liquids?
IDDSI Slightly Thick, Level 1 liquids are thicker than water but thinner than Mildly Thick, Level 2 liquids. They require minimal effort to drink compared to thin liquids and can flow through a straw or syringe. Examples of naturally occurring Slightly Thick, Level 1 liquids include:
- Tomato Juice
- Fruit Nectars
- Certain Nutritional Supplements
- Some Milks Containing Fat (Dairy and Non-Dairy)
Physiological Rationale
Slightly Thick, Level 1 liquids provide a slight increase in viscosity, which slows down the flow rate of liquids. This modification can be beneficial for individuals who have difficulty managing thin liquids but do not require the thickness of Level 2 or Level 3 liquids.
Clinical Benefits of Slightly Thick, Level 1 Liquids
Enhanced Swallowing Safety
The slightly increased thickness slows down the flow of liquid, allowing individuals better control during swallowing. This can reduce the risk of aspiration, where liquids mistakenly enter the airway or lungs. In addition, because of the lower viscosity, Slightly Thick, Level 1 liquids are less likely to leave post-swallow residue in the throat compared to thicker liquids.
Improved Hydration
Slightly Thick, Level 1 liquids closely resemble regular beverages in taste and mouthfeel, making them more palatable. This encourages adequate fluid intake, helping to maintain proper hydration—a common challenge in dysphagia management.
Preservation of Taste and Enjoyment
By minimally altering the sensory qualities of beverages, Slightly Thick, Level 1 liquids ensure that individuals can enjoy the taste and mouthfeel of their drinks. This enhances adherence to dietary recommendations and contributes to overall well-being.
Enhanced Nutritional Intake
The improved palatability and acceptance of Slightly Thick, Level 1 liquids can lead to higher intake of all beverages. For older adults at risk of malnutrition, meeting nutritional needs is particularly important for maintaining health and supporting overall functioning.
Positive Impact on Quality of Life
Slightly Thick, Level 1 liquids enable individuals to participate more fully in social dining experiences without drawing attention to their condition. This promotes social engagement and emotional well-being, reducing feelings of isolation that can accompany swallowing difficulties.
Emerging Uses for Slightly Thick, Level 1 Liquids
Expanded Clinical Options
Prior to the introduction of the IDDSI framework, Slightly Thick, Level 1 drinks were not commonly tested during bedside and instrumental assessments for individuals with swallowing difficulties. This changed with IDDSI, providing speech-language pathologists (SLPs) with a new intervention that may better suit certain patients’ needs.
Katrina Woodward, MS/CCC-SLP, CDP, explains, “When considering Slightly Thick, Level 1, we assess individuals who need a drink that is easier to control than thin, unthickened liquids, but does not leave excessive residue, which can occur with Mildly Thick, Level 2 drinks. Some patients currently on Mildly Thick, Level 2 may benefit more from Slightly Thick, Level 1 after proper assessment.”
This new option allows for the inclusion of Slightly Thick, Level 1 in clinical assessments both at the bedside and during instrumental examinations, ensuring that each patient receives the most appropriate and effective intervention for their specific swallowing needs.
Offering Slightly Thick, Level 1 liquids can be beneficial due to their more palatable consistency. This encourages individuals to drink more, supporting better hydration and reducing the risk of dehydration. According to Katrina Woodward, MS/CCC-SLP, CDP, “Slightly thick liquids differ the least from our taste-and-feel expectations of unthickened beverages and can be more appealing.”
Lubrication for Head and Neck Cancer (HNC) Patients
An emerging application of Slightly Thick, Level 1 liquids is in the management of xerostomia (dry mouth) for patients undergoing treatment for head and neck cancer. Radiation therapy can damage salivary glands, leading to decreased saliva production, difficulty swallowing, impaired taste, and reduced quality of life.
A solution proposed involves using xanthan gum-based Slightly Thick, Level 1 liquids as a saliva substitute. Xanthan gum can mimic the rheological properties of natural saliva, providing the necessary lubrication for chewing and swallowing. An unflavored aqueous solution at Slightly Thick, Level 1 consistency offers:
- Improved Mouthfeel and Lubrication: Assists in forming a cohesive bolus, facilitating easier swallowing.
- Taste Preservation: Being unflavored, it does not interfere with the taste of foods and beverages.
- Accessibility and Cost-Effectiveness: Xanthan gum is readily available, safe, and inexpensive, making it a practical option for patients.
This approach can restore swallowing functionality and enhance the eating experience for individuals whose salivary glands have been compromised due to radiation treatment. Additionally, the characteristics of Slightly Thick, Level 1 that benefit HNC patients could be applied to older adults experiencing dry mouth from medication or other causes. Slightly Thick, Level 1 liquids can aid in forming a bolus of food when eating or make swallowing pills easier, offering a versatile solution for various swallowing challenges.
Implementation in Clinical Practice
Assessment and Recommendation
Determining the appropriateness of Slightly Thick, Level 1 liquids should be based on a comprehensive assessment by a multidisciplinary team, including speech-language pathologists and registered dietitians. Clinical parameters and guidelines will help identify individuals who may benefit from these liquids
Consistency Verification
Employing the IDDSI Flow Test ensures that liquids meet the Slightly Thick, Level 1 consistency:
- Materials Needed: A 10 mL syringe (without a needle)
- Procedure:
- Fill the syringe with the liquid to the 10 mL mark, covering the nozzle with a finger.
- Release the finger and allow the liquid to flow for 10 seconds.
- After 10 seconds, the remaining liquid should measure between 1 mL and 4 mL to qualify as Slightly Thick, Level 1.
Visit IDDSI.org for more details on testing Slightly Thick, Level 1 liquids using the IDDSI Flow Test.
Conclusion
Slightly Thick, Level 1 liquids represent a valuable option in the management of dysphagia for selected individuals. When clinically appropriate, these liquids offer benefits that extend beyond swallowing safety to include improved hydration, enhanced nutrition, and a positive impact on quality of life.
Emerging uses, such as including Slightly Thick, Level 1 drinks during bedside or instrumental examinations and lubrication for head and neck cancer patients, highlight the versatility of Slightly Thick, Level 1 liquids in addressing specific needs. By incorporating them into personalized care plans, healthcare professionals can enhance dysphagia management strategies, ultimately supporting better health outcomes and well-being for individuals with swallowing difficulties.