Low Fluid Intake in Long-Term Care Residents with Dysphagia: Understanding and Exploring Solutions to a Persistent Care Challenge

Oropharyngeal dysphagia (swallowing difficulties) is common in older adults living with dementia in long-term care (LTC). Thickened liquids (TL) are widely prescribed to improve dysphagia symptoms. Growing evidence, however, suggests TL are not universally beneficial and may contribute to reduced fluid intake and dehydration, which has many negative health consequences. Residents with dementia and dysphagia often have the lowest levels of fluid intake compared to peers. Despite these realities, previous research has not examined how to effectively support hydration for residents living with dementia and dysphagia who drink TL. This PhD thesis, consisting of four interconnected manuscripts, aimed to address this gap using the Knowledge-to-Action Framework. The first manuscript, Chapter 2, was a systematic review synthesizing reported adverse outcomes associated with TL. Dehydration and reduced fluid intake were identified among the most common adverse outcomes in older adults. The second manuscript, Chapter 3, explored staff perspectives on the feasibility of implementing a multi-component hydration intervention for all LTC residents, which provided context and understanding for the subsequent chapters. Chapters 4 and 5 explored the development and evaluation of a hydration intervention specifically for residents with dementia and dysphagia who consume TL. Chapter 4 used participatory research methods to collaborate with interest-holders (residents, caregivers, and staff) to develop an intervention. The final manuscript, Chapter 5, was a pilot study evaluating the feasibility of implementing the newly identified intervention. This thesis provides a practical foundation for improving fluid intake among LTC residents living with dementia and dysphagia informed by the perspectives of various interest-holders. The findings highlight the importance of feasibility, collaboration, and context in the development and implementation of hydration interventions and may inform future work aimed at improving hydration for some of the most vulnerable residents in LTC.

Department dc:contributor.department

Rehabilitation Science

Year dc:date.issued

2026

Author dc:creator

• Werden Abrams, Sophia Nola

Advisor dc:contributor.advisor

• Namasivayam-MacDonald, Ashwini

Language dc:language.iso

en

Identifier URI

https://doi.org/10.71548/78

OAI record oai:identifier

https://macsphere.mcmaster.ca/server/oai/request?verb=GetRecord&metadataPrefix=dim&identifier=oai%3Amacsphere.mcmaster.ca%3A11375%2F33216