Barriers to oral fluid intake: beyond thickened liquids.

OBJECTIVES: Substandard oral fluid intake in poststroke patients receiving thickened liquids has been well documented; however, more recently, it has been reported in poststroke patients receiving thin liquids. Factors contributing to substandard fluid intake have been limited to the altered taste/texture of thickened beverages. The aim of this study was to determine if functional deficits poststroke based on admission Functional Independence Measure (FIM) scores for expression, problem solving, memory, and eating as well as dysphagia severity predict oral fluid intake for poststroke patients regardless of liquid viscosity. A second aim was to determine if there is a significant difference in the amount of oral fluids offered and consumed between patients receiving thin liquids and patients receiving thickened liquids. METHODS: Thirty-nine patients with a new diagnosis of ischemic stroke participated. Patients were assigned to one of two groups based on the consistency of liquids they were receiving: group 1, 21 receiving thin liquids, and group 2, 18 receiving nectar or honey consistency. Fluids offered and consumed were monitored for 72 consecutive hours. Admission FIM scores and dysphagia severity ratings were collected. RESULTS: Functional deficits in eating significantly predicted oral fluid intake in the thin-liquid group (p = .0575), whereas functional deficits in cognition (memory and problem solving) significantly predicted oral fluid intake in the thickened-liquid group (p = .0037). Patients receiving thin liquids consumed significantly more than patients receiving thickened liquids (mean = 1,405.45 ml and SD = ±727.1 ml vs. mean = 906.58 ml and SD = ±317.4 ml; p = .0031); however, they were also offered significantly more fluids (mean = 2,574.7 ml vs. 1,588.9 ml, p = .0002). CONCLUSIONS: On average, poststroke patients consume substandard amount of fluid during hospitalization, regardless of viscosity. Although patients receiving thin liquids consumed significantly more, they were offered, on average, approximately 1,000 ml more fluids per 24-hour period than the thickened-liquid group. Functional deficits after stroke influence oral fluid intake and should be considered as potential barriers to fluid intake for poststroke patients.

Adequate oral fluid intake in hospitalized stroke patients: does viscosity matter?

PURPOSE: Sufficient intake of oral fluids to meet hydration needs is a critical recovery issue for patients hospitalized post stroke. Concerns for adequate oral fluid intake are generally focused on dysphagic patients restricted to thickened liquids; however, fluid intake patterns in stroke patients receiving thin liquids are unknown. METHOD: This study examines the oral fluid intake patterns of three groups over 72 hours: community dwelling individuals, patients hospitalized post stroke receiving thin liquids and patients hospitalized post stroke receiving thickened liquids. RESULTS: Mean oral fluid intake differed significantly between the two hospitalized groups (p = .04), with individuals receiving thickened liquids consuming less. Less than 1% of patients hospitalized post stroke met a minimum standard of 1500 mL/day, regardless of liquid viscosity. Conversely, community dwelling participants consumed significantly more fluids on average than their hospitalized counterparts. CONCLUSION: Compliance with beverage preference, frequency of beverage offering, and inaccurate preparation of thickened beverages were identified as factors potentially influencing fluid intake.