This study also compared drinking regular thin liquids using a chin down head posture as well as drinking regular thin liquids without any changes to head position the main outcome was fluid entering the lungs. The first of the two studies looked at the immediate effects of two viscosities of liquids compared to regular thin liquids on aspiration (entry of food or fluid into the lungs) in 351 people with dementia. ![]() We included data on people with dementia only. We found two studies, which were both part of the same multicentre trial and included people with dementia and people with or without dementia and Parkinson's disease. We wanted to examine if modifying food or fluids, or both, also had any adverse effects for the person with dementia. We wished to find out if changing the viscosity or consistency of food or fluids, or both, makes swallowing safer and has positive outcomes for people with dementia in terms of respiratory status, nutritional status and quality of life. However, there is growing evidence suggesting that this strategy can lead to dehydration, malnutrition, negative psychological/social consequences, and can affect quality of life for the person with dementia. It is believed that increasing the viscosity of liquids or altering the consistency of food allows individuals a better opportunity to swallow, with a reduced risk of choking or liquids entering the airway. Modification of food and liquid is a popular management strategy. The consequences can include choking, dehydration, malnutrition, weight loss, pneumonia and death. Individuals with dementia often present with swallowing difficulties (dysphagia). Modifying the consistency of food and fluids for swallowing difficulties in dementia The overall quality of evidence for outcomes in this review is low. There were no deaths classified as 'definitely related' to the type of fluids prescribed. During the second three‐month follow‐up trial, there were a greater number of incidents of pneumonia in participants receiving honey thick liquids than those receiving nectar thick liquids or taking regular liquids with a chin down posture. Honey thick liquids, which are more consistent with descriptors for 'spoon thick' or 'extremely thick' liquids, showed a more positive impact on immediate elimination of aspiration during videofluoroscopy, but this consistency showed more adverse effects in the second follow‐up study. Outcomes were pneumonia and adverse intervention effects. ![]() The second study, a parallel designed RCT, compared the effect of nectar and honey thick liquids with a chin down head posture over a three‐month period in a subgroup of 260 participants with dementia. The sequence of interventions during videofluoroscopy may have influenced response to intervention. Regular liquids with a chin down head posture, as well as regular liquids without any intervention were also compared. The first study, a cross‐over trial, investigated the immediate effects on aspiration of two viscosities of liquids (nectar thick and honey thick) compared to regular liquids in 351 participants with dementia using videofluoroscopy. With unpublished data supplied by study authors, we examined data from participants with dementia only. Participation in the second trial was determined by results from the first trial. Both were part of the same large multicentre trial and included people with dementia and people with or without dementia and Parkinson's disease. We included two studies that examined modification to fluids. ![]() No trials on modification of food met the inclusion criteria.
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