Thickened fluids: Supporting choice, nutrition, hydration and safety

Older people can develop eating, drinking and swallowing difficulties (dysphagia) that increase the risk of something going wrong when they eat or drink (such as choking or inhaling food particles or liquid).

Following individual assessment of an older person, a speech pathologist may recommend giving them thickened fluids to help deal with these problems.

Thickening fluids slows down the flow and improves control in the person’s mouth and throat. This can reduce the risk of aspiration (where fluid enters the airway and passes into the lungs instead of down the throat and into the stomach).

It's important that when an older person begins thickened fluids, their choices are not limited. You should take their individual preferences into consideration and review this regularly to make sure they drink enough fluids to stay hydrated. Water should also be part of the fluids on offer.

Symptoms and severity of dysphagia affect people differently and can change over time. Providers should:

closely monitor each person’s eating and drinking of recommended texture modified foods and thickened fluids
refer people for reassessment by a speech pathologist in line with their needs.

A person has the right to choose how they eat and drink. It’s important that they understand their options, benefits and any risks so they can choose what is right for them.

A speech pathologist can guide you on the management strategies and options available to the older person. This should be supported by kitchen staff and dietitians to make sure that fluids are delicious and nutritious.

Thickened fluids: top tips

Make sure staff are trained to prepare thickened fluids effectively and safely to the level recommended by the speech pathologist and following a standardised framework such as the International Dysphagia Diet Standardisation Initiative (IDDSI).
Any beverage can be thickened. Make sure people who need thickened fluids are included in happy hour and social outings and can enjoy their beverage of choice. Common happy hour drinks including wine, beer, milk, juice and carbonated beverages, all can be thickened in line with the IDDSI framework.
Make sure people drinking thickened fluids are staying hydrated, particularly in hot weather or if taking diuretics. Some people may find it hard to drink enough, especially if they’re not enjoying what they’re being given. This might include documenting how much fluid they’re having.
Make sure a person’s nutritional needs are still being met by looking at the nutritional content of both food and fluids. Careful choice of thickened fluids can support nutrition as well as hydration.
Make sure people who have swallowing difficulties but who prefer to have drinks that are not thickened are supported to make an informed decision. This decision, known as eating and drinking with acknowledged risk (EDAR), should be made in consultation with the person, the speech pathologist and any other supporting multidisciplinary team members. The decision should be regularly reviewed.

Find out more:

Swallowing resources:

The Commission has online training available on the Aged Care Learning Information System (Alis) for providers and staff to learn about texture modified food and thickened fluids and to help promote change.

Select the Food, nutrition and dining program and the Eating, drinking and swallowing difficulties course to find out more. The Using Modified Food and Fluids module:

defines and describes texture modified food and thickened fluids
separates the myths from facts when it comes to modifying food and fluids
describes things to consider when planning and preparing modified food and fluids
explains what best practice looks like.