September/October 2019

Nutrition and Lifestyle: Latest Food Products for Dysphagia Patients
By Brianna Tobritzhofer, MS, RD, LD
Today’s Geriatric Medicine
Vol. 12 No. 5 P. 10

Dysphagia is a common condition among older adults. Those with dysphagia often experience anxiety and panic during mealtimes, which may lead to social isolation, reduced food intake, and/or avoidance of meals altogether.1 If untreated, malnutrition, dehydration, respiratory infections, and silent aspiration can result.2

However, geriatricians play an important role in optimizing nutrient intake in patients with this condition. There are several food products on the market formulated specifically for dysphagia to make mealtimes easier—and safer—for patients. It’s important for those who work with older adults to become familiar with the products on the market, know how to use them, and understand their nutrient content.

This article provides an overview of some of the more popular dysphagia-specific food products to help geriatricians make informed recommendations to patients and their families.

What Is Dysphagia?
Dysphagia refers to any disruption in the swallowing pro- cesses.3 The two major types are oropharyngeal dysphagia, which involves having trouble with the initiation of the swallow, and esophageal dysphagia, which involves difficulty passing food from the esophagus to the stomach.

In older adults, physiological changes may trigger impaired swallowing function, such as reductions in muscle mass and connective tissue elasticity. In addition, dysphagia may result from age-related illnesses, such as stroke, dementia, and Parkinson’s disease, that affect the swallowing mechanism.4

Despite how common it is among older adults, dysphagia isn’t a normal part of aging, but its management in this population is especially important to maintain nutrition status and overall quality of life.4

Prevalence
The prevalence of dysphagia in older adults is unclear, but it’s been estimated that approximately 15% of this population is affected.4 Individuals older than 65 have seven times the risk of complications from dysphagia, such as choking on food, than that of children aged 1 to 4.2

The prevalence of dysphagia seems to be higher among older adults living in nursing homes and assisted living facilities, where up to 60% of residents have been reported to have difficulties related to food intake.3

Treatment
Treatment for dysphagia in older adults must be individualized, but the primary goal is to ensure safe swallowing.5 The cause, nature, and severity of dysphagia will determine which treatment modalities are chosen for each patient.

Diet modifications are frequently recommended, which require intervention from geriatricians to optimize their success. Dietary strategies for dysphagia management may include altering food textures and modifying liquid consistencies. These are known to help improve swallowing safety while promoting oral intake, which may in turn improve patients’ ability to meet their nutritional needs.

The National Dysphagia Diet Task Force has established standardized nutrition therapies for dysphagia management, such as the National Dysphagia Diet, which includes specific guidelines outlining three levels of food textures and four different types of liquids best suited for patients with mild to moderate to severe dysphagia.6

The levels of solid foods include ground/purée (level 1), mechanical soft/chopped (level 2), and regular/advanced (level 3), which help patients compensate for chewing difficulties or fatigue and improve swallowing safety.7 Liquids typically are thickened to help patients avoid aspiration and control the speed, direction, duration, and clearance of the bolus while improving transit through the esophagus.6 The four thickness levels of liquids are thin, nectar thick, honey thick, and spoon thick.

Several studies have shown that offering more food choices for dysphagia patients can lead to greater nutritional intake.4 This can be challenging, especially for those who require modified food textures, as they aren’t always accessible, appetizing, or convenient for patients and their caregivers outside of long term care facilities. In recent years, food products formulated specifically to address these struggles have become more readily available. Those who work with older adults can recommend these as an intervention for dysphagia to help improve food intake and quality of life.

The following is a sampling of hundreds of available products, including information about nutrient content and price ranges.

NutraBalance
NutraBalance sells prethickened water in nectar, honey, and pudding consistencies. What makes its products unique is its use of cellulose gum, a tasteless and odorless thickening agent. Because it doesn’t leave a starchy aftertaste, it may be more palatable than other products for some patients.

NutraBalance products are available at https://nutra-balance-products.com/shop/pre-thickened-liquids. They range in price from $57.16 to $60.27 per case of eight 32-oz bottles.

Thick-It
This company offers several prethickened beverages, including water, coffee, tea, and juice in nectar and honey consistencies. The beverages are thickened with xanthan gum and don’t contain added sugars. They’re easy to use and versatile in that they can be chilled, heated, or frozen.

They’re available at http://thickit.com/products or at any pharmacy. Nutrition information, which varies for each beverage, can be found online. Price ranges depend on where the products are purchased.

Simply Thick
Simply Thick has several dysphagia-specific products available for purchase by patients and health care professionals.

One of its most popular products is EasyMix premeasured thickening packets, available in nectar and honey consistencies. Packaged in individual servings, they’re designed to thicken 4 oz of liquid. Patients on the go and looking for convenience will benefit from these products.

Simply Thick products are available at www.simplythick.com. One honey-thick packet contains 10 kcal, 45 mg sodium, and 3 g carbohydrate, while one nectar-thick packet contains 5 kcal, 20 mg sodium, and 1 g carbohydrate. One hundred individual packets cost $59.95 to $69.95.

Parapharma Tech
Parapharma Tech markets Purathick, an organic powdered thickener for hot and cold beverages that contains tapioca maltodextrin, tara gum, and calcium carbonate. Purathick is free of corn, wheat, gluten, soy, whey, casein, lactose, and dairy, making it an excellent option for dysphagia patients with food allergies and sensitivities. Purathick can thicken liquids to reach a nectar, honey, or pudding consistency.

Purathick is available at the Parapharma Tech website (www.healthierthickening.com/purathick), Amazon, or pharmacies in bulk or in individual packets. One scoop contains 10 kcal, 2 g carbohydrate, and 1 g fiber. A 4.4-oz jar costs $19.95, and a box of 30 individual serving sticks costs $16.95.

Hormel Health Labs
Hormel Health Labs offers several dysphagia-specific products, including a variety of frozen puréed foods that are appropriate for a level 1 dysphagia diet. The selection of puréed foods includes shaped meats, side dishes, vegetables, fruits, and breakfast items. Moreover, Hormel Health Labs provides individual puréed meals, from beef lasagna to French toast. These products can be recommended to patients who don’t have the ability to purée foods and need quick, convenient meal options.

Individual patients and health care professionals can order these products online from homecarenutrition.com or food- servicedirect.com. Nutrition information and prices are available online at www.hormelhealthlabs.com/condition/dysphagia/pureed-foods.

Kate Farms
Oral nutritional supplements can be a solution for dysphagia patients who need support for meeting energy needs. While Ensure and Boost commonly are recommended in these cases, there are many other companies, such as Kate Farms, that offer similar products. It manufactures nutritionally complete oral nutrition supplements free from dairy, soy, gluten, corn, and nuts, with an added phytonutrient blend that provides a boost of antioxidants.

These products can be purchased directly from the company’s website at www.katefarms.com/conditions/dysphagia as either a one-time purchase or a monthly subscription. One 325-mL carton contains 325 kcal, 12 g fat, 225 mg sodium, 38 g carbohydrate, 5 g fiber, and 16 g protein. A case of 12 cartons costs $46.

RESOURCE ThickenUp
Nestlé Health Science offers RESOURCE ThickenUp, a modified corn starch powdered thickener for hot and cold foods and beverages. ThickenUp is available in 0.22-oz packets and 8-oz containers. Each packet contains 25 kcal and 6 g carbohydrate and should be mixed with 6 oz of liquid for nectar consistency and 4 oz of liquid for honey consistency. Seventy- five packets cost $32.99.

ThickenUp Clear, a powder made from maltodextrin, xanthan gum, and potassium chloride, is also available in 4.4-oz canisters or 1.4-g sticks. One scoop or stick thickens to nectar consistency, two to honey consistency, and three to pudding consistency. A single canister costs $9.99, and each scoop or stick contains 5 kcal and 1 g carbohydrate.

ThickenUp products are available from Nestlé Health Science (www.nestlenutritionstore.com) or Amazon.

Whether patients need prethickened beverages, frozen puréed meals, or oral nutritional supplements, there are products on the market that address almost every challenge dysphagia patients may face.

— Brianna Tobritzhofer, MS, RD, LD, is the senior manager of nutrition and client services for a nonprofit meal delivery program in Minneapolis. She’s also a freelance health and nutrition writer and author of her blog Fresh Fit Flourish.

References
1. Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychosocial burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17(2):139-146.

2. Cichero JAY. Age-related changes to eating and swallowing impact frailty: aspiration, choking risk, modified food texture and autonomy of choice. Geriatrics. 2018;69(3):1-10.

3. Aslam M, Vaezi MF. Dysphagia in the elderly. Gastroenterol Hepatol (N Y). 2013;9(12):784-795.

4. Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7:287-298.

5. Nawaz S, Tulunay-Ugur OE. Dysphagia in the older patient. Otolaryngol Clin North Am. 2018;51(4):769-777.

6. Cichero JA, Steele C, Duivestein J, et al. The need for international terminology and definitions for texture-modified foods and thickened liquids used in dysphagia management: foundations of a global initiative. Curr Phys Med Rehabil Rep. 2013;1:280-291.

7. Cichero JA, Lam P, Steele CM, et al. Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia. 2017;32(2):293-314.