March 2019 Issue

Senior Wellness: Latest Food Products for Dysphagia Patients
By Brianna Tobritzhofer, MS, RD, LD
Today’s Dietitian
Vol. 21, No. 3, P. 16

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

This article provides an overview of some of the more popular dysphagia-specific food products to help nutrition professionals make informed recommendations to patients and their families who are impacted by the condition.

What Is Dysphagia?
Dysphagia refers to any disruption in the swallowing processes.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 the elderly, physiological changes may trigger impaired swallowing function, such as reductions in muscle mass and connective tissue elasticity.4 In addition, dysphagia may result from age-related illnesses that affect the swallowing mechanism, such as stroke, dementia, and Parkinson’s disease.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 has been estimated that approximately 15% of this population is affected.4 Individuals older than age 65 have seven times the risk of complications from dysphagia, such as choking on food, than 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 RDs 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 compensate for chewing difficulties or fatigue and improve swallowing safety.7 Liquids typically are thickened to control the speed, direction, duration, and clearance of the bolus to help avoid aspiration and improve 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 nutrient 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. RDs who work with older adults can recommend these as an intervention for dysphagia to help improve food intake and quality of life.

The following are names of several food companies and the dysphagia-specific products they offer, including nutrient content and price ranges.

NutraBalance
NutraBalance is known for selling prethickened water, which is available 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, this may be more palatable for some patients.

NutraBalance products are available for purchase online 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 any added sugars. They’re easy to use and versatile in that they can be chilled, heated, or frozen.

Patients and health care providers can purchase these beverages online (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 product is 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, which are available in nectar and honey consistencies. Packaged in individual servings, they’re designed to thicken 4 oz of liquid at a time. On-the-go patients looking for convenience will benefit from these products.

Simply Thick products are available for purchase online 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, 1 g carbohydrate. One hundred individual packets cost $59.95 to $69.95.

Parapharma Tech
Parapharma Tech is known for Purathick, an organic powdered thickener for hot and cold beverages that includes 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. Patients can buy it 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 on their own and need quick, convenient meal options.

Individual patients and health care professionals can order these products online from homecarenutrition.com or foodservicedirect.com. Nutrition information and prices, which vary depending on the product, can be viewed online at www.hormelhealthlabs.com/condition/dysphagia/pureed-foods.

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

Anyone can purchase these products directly from the company 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 should be mixed with 6 oz of liquid for nectar consistency and 4 oz of liquid for honey consistency, and contains 25 kcal and 6 g carbohydrate. Seventy-five packets costs $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 for purchase through Nestlé Health Science (www.nestlenutritionstore.com) or Amazon.

Hundreds of other companies offer food products for dysphagia patients, but these listed here are a great place to start for RDs. Whether patients need prethickened beverages, frozen puréed meals, or oral nutritional supplements, there are food products on the market that address just about every challenge that 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.