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Multicenter Study
. 2024 Jul 1;184(7):778-785.
doi: 10.1001/jamainternmed.2024.0736.

Thick Liquids and Clinical Outcomes in Hospitalized Patients With Alzheimer Disease and Related Dementias and Dysphagia

Alexander Makhnevich  1   2   3 , Alexandra Perrin  1   3 , Dristi Talukder  1   3 , Yan Liu  1   3 , Stephanie Izard  1   3 , Codruta Chiuzan  1   3 , Stefani D'Angelo  1   3 , Rebecca Affoo  4 , Nicole Rogus-Pulia  5   6 , Liron Sinvani  1   2   3
Affiliations
Multicenter Study

Thick Liquids and Clinical Outcomes in Hospitalized Patients With Alzheimer Disease and Related Dementias and Dysphagia

Alexander Makhnevich et al. JAMA Intern Med. .

Abstract

Importance: Oropharyngeal dysphagia is common in hospitalized patients with Alzheimer disease and related dementias (ADRD). Although the use of thick liquids in patients with dysphagia has been shown to reduce aspiration on direct visualization, there is no clear evidence that this practice translates into improved clinical outcomes.

Objectives: To determine whether a diet of thick liquids compared with thin liquids is associated with improved outcomes in hospitalized patients with ADRD and dysphagia.

Design, setting, and participants: This cohort study included adults aged 65 years and older with ADRD who were admitted to the medicine service across 11 diverse hospitals in New York between January 1, 2017, and September 20, 2022, with clinical suspicion of dysphagia during hospitalization and survival for at least 24 hours after hospital arrival. Patients were grouped according to whether at least 75% of their hospital diet consisted of a thick liquid diet or a thin liquid diet. Propensity score matching was used to balance covariates across the 2 groups for the following covariates: demographics (eg, age, sex), baseline clinical characteristics (eg, Charlson Comorbidity Index), and acute presentation (eg, respiratory diagnosis, illness severity, delirium).

Main outcomes and measures: Hospital outcomes included mortality (primary outcome), respiratory complications (eg, pneumonia), intubation, and hospital length of stay (LOS).

Results: Of 8916 patients with ADRD and dysphagia included in the propensity score matched analysis, the mean (SD) age was 85.7 (8.0) years and 4829 were female (54.2%). A total of 4458 patients receiving a thick liquid diet were matched with 4458 patients receiving a thin liquid diet. There was no significant difference in hospital mortality between the thick liquids and thin liquids groups (hazard ratio, 0.92; 95% CI, 0.75-1.14]; P = .46). Compared with patients receiving thin liquids, patients receiving thick liquids were less likely to be intubated (odds ratio [OR], 0.66; 95% CI, 0.54-0.80), but they were more likely to have respiratory complications (OR, 1.73; 95% CI, 1.56-1.91).

Conclusions and relevance: This cohort study emphasizes the need for prospective studies that evaluate whether thick liquids are associated with improved clinical outcomes in hospitalized patients with ADRD and dysphagia.

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Conflict of interest statement

Conflict of Interest Disclosures: Ms Izard reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study. Ms D’Angelo reported working on grants from NIH during the conduct of the study. Dr Rogus-Pulia reported financial support from the University of Wisconsin-Madison and grants from the NIH outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flow Diagram of the Propensity Score–Matched Participants
ADRD, Alzheimer disease and related dementias.
Figure 2.
Figure 2.. Kaplan-Meier Survival Estimates According to Thick or Thin Liquid Diet for the First 14 Days Only
See this image and copyright information in PMC

Comment on

References

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