Food and Liquid Consistency Modification for Safe Swallowing in Elderly with Dysphagia Risk


  • Benjapornlert P Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University. 270 Rama VI, Ratchathewi, Bangkok, Thailand 10400
  • Tuakta P Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University. 270 Rama VI, Ratchathewi, Bangkok, Thailand 10400
  • Kimhiah B Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University. 270 Rama VI, Ratchathewi, Bangkok, Thailand 10400
  • Wongphaet P Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University. 270 Rama VI, Ratchathewi, Bangkok, Thailand 10400
  • Kriengsinyos W Institute of Nutrition, Mahidol University. Salaya, Phutthamonthon, Nakhon Pathom, Thailand 73170
  • Wattanapan P Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University. 123 Mittraphap Rd., Nai Mueang, Mueang Khon Kaen District, Khon Kaen, Thailand 40000
  • Jatchavala J Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University. 270 Rama VI, Ratchathewi, Bangkok 10400 Thailand


deglutition disorder, oropharyngeal dysphagia, food


Objectives: This study aimed to evaluate the effect of food and liquid consistency modification on swallowing safety in healthy elderly with dysphagia risk.

Study design: Cross-sectional analytical study.

Setting: Outpatient clinic, Department of Rehabilitation Medicine, and Radiology Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University.

Subjects: Healthy elderly age > 65 who had mild to moderate dysphagia symptom, as defined by the 10-item Eating Assessment Tool (EAT-10) score ≥ 3

Methods: Each participant was performed a water swallowing test (WST), oropharyngeal physical examination, and videofluorographic swallowing study (VFSS). A bolus test, including four varying liquid consistencies and four modified food textures according to the International Dysphagia Diet Standardisation Initiative (IDDSI), was investigated. The Penetration-Aspiration Scale (PAS) was used to identify a primary outcome of safe swallow, which scores ≥ 2 was considered a high risk of penetration and aspiration. The residue in the oropharyngeal area was demonstrated by a pooling score (P-score), which was abnormal if ≥ 6.  The pharyngeal transit duration (PTD) was also illustrated.

Results: Thirty-four subjects with a mean age of 72.0 (SD 6.8) years and mean EAT-10 score of 5.3 (SD 2.4) underwent VFSS. None of the subjects showed aspiration. The large volume of thin liquid (10 mL) revealed the highest frequency of penetration, 20.6%. There was no penetration during the test with 4 mL of moderately thick, extremely thick liquids, and all modified foods. A 10 mL of thin liquid and a pureed food were the highest occurrences of residue, 23.5%. Average PTD of regular food was the slowest at 120 ms, while small volume (4 mL) of thin liquid was the fastest at 69 ms.

Conclusion: In the elderly with dysphagia risk, a large bolus of thin liquid constituted the highest risk of penetration and aspiration.  No penetration was found during the modified food test. However, a high frequency of abnormal pooling of residue was found after swallowing a pureed food and a large amount of liquid


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