Hierarchy Of Consistencies And Quantities

Question 0

What are the ranges of liquid viscosities?

Answer 0

Thin (water)

Naturally thick (milkshake, smoothie etc)

Thickened:

Stage 1: through a straw (thin syrup)

Stage 2: cannot be drunk through a straw, leaves thick coat on spoon (thick syrup)

Stage 3: needs to be taken with spoon (custard)

Question 1

Why do we need to thicken fluids?

Answer 1

Because water loses its cohesion after one second therefore if a clients swallow is delayed the risk of penetration and aspiration is significantly increased

Thickened fluids move more slowly, providing the individual with more time to initiate a swallow

Question 2

What are the arguments against using puréed consistencies?

Answer 2

a) they have a tendency to not be nutritionally complete
b) it is not a normal texture for most people
c) it is difficult for people to differentiate between the different tastes they are given
d) there is a tendency for carers to mix portions of purées together

Question 3

What are better to use than purées?

Answer 3

Soft, easy chew foods

A normal consistency with gravy

This is because these textures are more familiar to patients and are therefore more likely to stimulate a swallow

Question 4

What are the advantages and disadvantages of using fizzy drinks?

Answer 4

Advantages:
Nixon (1997) suggests carbonation facilitates faster oral and pharyngeal transit times; decreases incidence of pooling and penetration and improves laryngeal elevation decreasing the incidence of aspiration when compared with non fizzy thin fluids

Fizzy drinks may heighten the persons awareness of the bolus in the oral cavity increasing the speed of the initiation of the swallow

Carbonated drinks are normally drunk chilled which may add to the stimulating effect

May be more acceptable to patients than thickener

Disadvantages
Since they are normally sweet they may pose increased risk if aspirated

Implications for oral health

Question 5

Therefore, when should fizzy drinks be recommended?

Answer 5

May be most suitable for patients experiencing mild problems such as penetration

Question 6

What are the ranges of food consistencies?

Answer 6

Thin purée:
No chewing, no bits, forms a cohesive bolus but does not hold its shape, cannot be eaten with a fork and can be poured (cream of soup)

Thick purée:
No chewing, smooth, no bits, holds its shape, cannot be poured (forticreme)

Pre-mashed:
Soft, moist, little chewing, no mixed consistencies, holds its shape (smash)

Fork mashable: soft, moist, needs some chewing, no hard crumbly bits, thick sauce (cottage pie)