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Nectar Thick Liquids: Helping Seniors Stay Safe

Written by Kierra Brown, RD & reviewed/edited by Katie Dodd, MS, RDN, CSG, LD, FAND

Kierra is a Dietitian & is pursuing her M.S. in Nutrition Sciences at Indiana University Pennsylvania.

Important: Anytime you have swallowing issues, consult with your medical team (including physician and speech-language pathologist). Recommendations for food and fluid modification are always individualized.

This article is intended to provide a brief overview of swallowing difficulties and have information for those instructed to consume nectar thick liquids.

Why is my Family Member Coughing More When Drinking?

Coughing while eating or drinking may be a sign of a swallowing problem. Understanding a normal swallow can help you identify signs of an abnormal swallow.

Normal swallow

Swallowing is a complex process that involves nearly 50 muscles and a dozen nerves. It moves food and fluids from the mouth to the stomach.

The three phases of swallowing:

  • oral
  • pharyngeal
  • esophageal

The first two phases are voluntary (you intentional make the swallow happen). Whereas, the esophageal phase is involuntary (it just happens).

Changes in Your Swallow as You Age

Changes in the tongue, upper throat (pharynx), vocal cords or voice box (larynx) and throat (esophagus) can occur with aging. These changes may lead to dysphagia (problems swallowing). Dysphagia is not a part of normal aging, but older age is a risk factor. Furthermore, risk of dementia increases with age and can negatively impact swallowing. For more information about nutrition care and dementia click here.

What to Do If You Have Concerns

If you are concerned that someone you care for has swallowing problems, there are things you can do. Monitor them during mealtimes to document any difficulties or challenges while eating or drinking. Share concerns with a physician who will most likely refer your loved one to a speech-language pathologist (SLP). A SLP can determine the appropriate texture of solids and liquids needed for an individual with swallowing difficulty.

Dysphagia

As previously mentioned, dysphagia is swallowing difficulty. But let’s dig a little deeper.

What is Dysphagia?

Dysphagia is difficulty swallowing caused by disease or dysfunction of the mouth, pharynx, larynx, or esophagus. Dysphagia can be caused by conditions such as cancer, neurological disorders, or even heartburn. Symptoms include food getting “stuck”, choking while eating, coughing while eating, drooling, regurgitation of food, and recurrent lung infections.

Types of Dysphagia

The type of dysphagia depends on the swallowing phase involved. Esophageal dysphagia refers to the feeling of food being stuck in the base of your throat or chest after swallowing. Oropharyngeal dysphagia makes it difficult to move food from mouth to throat. Individuals may choke, gag or cough when eating or drinking.

Risk of swallowing problems

Health Impact of Undiagnosed Dysphagia

Dysphagia can negatively impact health. It can lead to complications such as aspiration, aspiration pneumonia, weight loss, malnutrition, and dehydration.

Silent Aspiration

Aspiration occurs when foreign objects such as food or liquids enter your airway. Commonly described as “food going down the wrong way.” Silent aspiration is called “silent” for a reason. There are often no symptoms and people do not realize food/fluids have entered their lungs. Changes in voice or breathing may be a sign that the person is aspirating.

Aspiration Pneumonia

Aspiration increases risk for aspiration pneumonia. Food entering the airway when swallowing introduces bacteria into the lungs. This in turn leads to aspiration pneumonia.

Poor oral hygiene and tooth decay are also associated with aspiration pneumonia. Learn about dental health for older adults to minimize the risk for developing aspiration pneumonia.

Weight Loss and Malnutrition

Dysphagia can make it difficult to maintain adequate intake of food. When you have a hard time swallowing eating can really become a chore. This can cause weight loss which can lead to malnutrition. Small, frequent meals and/or high calorie beverages may be beneficial. Click here to see recipes for weight gain smoothies! Overall, unintended weight loss and malnutrition have a negative impact on activities of daily living and independence.

Dehydration

People with swallowing problems often do not get enough fluids. Dysphagia can make it difficult to maintain adequate hydration; therefore, thickening liquids makes it safe for individuals to drink.

Encourage fluids frequently to minimize risk of dehydration. Fluid can also be obtained from foods such as oranges or watermelons, but consider the consistency if the person you are caring for is following a modified texture or consistency diet.

Liquid Consistencies for Dysphagia Diet

There are three levels of thickened liquids:

  • nectar thick
  • honey thick
  • pudding thick

Liquid consistencies needed will depend on the severity of the dysphagia.

Nectar Thick

The first level of modified consistency for liquids is nectar thick. Nectar thick liquids are thicker than water, fall slowly from a spoon, and are sipped through a straw or from a cup. For example, buttermilk and fruit nectars are nectar thick.

Honey Thick

Honey thick liquids are “sippable” from a cup, drop from a spoon but are usually too thick to be sipped with a straw. Tomato sauce and honey are considered honey thick. Honey thick liquids are between nectar thick and pudding thick.

Pudding Thick

The thickest liquid consistency is pudding thick. Pudding thick liquids maintain their shape, are too thick to drink in the traditional sense and need to be taken with a spoon. Pudding thick liquids are intended for individuals with severe dysphagia.

What to Do When You Need Nectar Thick Fluids?

There are commercial thickeners available. Pre-made thickened liquids are also available.

Use Commercial Thickening Products

Commercial thickeners are available at pharmacies to thicken beverages, soups, and pureed foods as needed. Guidelines on how to thicken beverages are provided on the product label. Using a commercial thickener allows you to thicken additional beverages and increase variety of fluid choices available.

Use Pre-made Nectar Thick Fluids

Beside commercial thickening products,pre-made nectar thick fluids are available for purchase. Thickened water, juice, tea, coffee, and milk may be available at the pharmacy or online. Pre-made nectar thick fluids are convenient and require no mixing.

Liquids to Thicken

Fluids for Nectar Thick Consistency

Most fluids can fit within a nectar thick liquid diet. Be sure to thicken these fluids to the appropriate consistency. Although most fluids are acceptable, certain ones should be avoided.

Fluids to Choose to Thicken

Thin liquids like water, milk, tea, coffee, carbonated beverages, and juice need to be thickened. Some beverages such as smoothies and milkshakes may already be at the appropriate nectar thick consistency but watch out for melting. Frozen liquids are not thick liquids. Consider the consistency of liquids if they melt. Ice is solid, but in the mouth becomes a thin liquid.

Fluids to Avoid on a Nectar Thick Diet

On a nectar thick diet, individuals should avoid all thin liquids that have not been thickened. As previously mentioned, anything that melts such as ice cream, popsicles, frozen yogurt, and ice cubes should be avoided. Also, fluids combined with solids such as chunky soups and Jell-O with fruit should be avoided.

How Can Caregivers Help?

Caregivers can help by following guidance from SLP, promoting adequate hydration, and safely providing nectar thick liquids.  Always consult with an individuals medical team for individualized advice. Avoid treating all individuals with swallowing difficulties the same or as you have with patients in the past. Not everyone with dysphagia needs thickened liquids.

Promote Intake of Nectar Thick Fluid for Hydration

Offer nectar thick fluids at all meals and between meals to promote intake. Hydration is very important. Consider thickened high calorie shakes to promote hydration and minimize weight loss.

Safe Mixing of Fluids

Follow all guidelines or instructions on commercial thickeners to safely thicken fluids. Avoid adding ice to liquids to cool them down (remember, water is a thin liquid). Basic guidelines are 1 ½ teaspoons of thickener to ½ cup liquid then stir vigorously and wait at least 2 minutes before serving.

Conclusion

Increased age is a risk factor for dysphagia but not every older person experiences dysphagia. Managing a swallowing disorder such as dysphagia may involves modifying the texture of liquids. Nectar thick liquids can be purchased already thickened or made by hand by purchasing commercial thickeners.

If dysphagia is left untreated it can cause severe consequences such as aspiration pneumonia or malnutrition. Caregivers should be on the look out for swallowing problems and promote nectar thick liquids for hydration as needed.

References

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