Stroke is more prevalent in the elderly (National Centre for Monitoring Cardiovascular Disease, 2004) and they may be particularly vulnerable to the effects of dysphagia following stroke due to the age- related changes to swallowing, termed presbyphagia (Logemann, Pauloski, Rademaker, & Kahrilas, 2002; Logemann, Pauloski, Rademaker, Colangelo, Kahrilas, & Smith, 2000; Robbins, Duke Bridges, & Taylor, 2006). Dysphagia also compounds the sen- sory and physiological changes experienced by people who are getting older, e.g., reduced perception of thirst, a lower percentage of total body water, and a reduced ability of the kidneys to concentrate urine (Bennett, 2000), increasing the risk for dehydration. In addition, some elderly people have a greater use of medications affecting water losses, particularly diuret- ics, sedatives, antipsychotics, tranquilizers, and non- steroidal anti-inflammatory drugs (Lavizzo-Mourey, Johnson, & Stolley, 1988). External factors such as the environmental temperature, amount of physical activ- ity, and even involuntary activity due to tremors and dystonias may also affect hydration status (Grandjean, 2005). For these reasons, the fluid requirements for each individual to maintain an adequate degree of hydration vary considerably. Despite these concerns for the hydration status of the elderly, healthy and independent older Introduction Dysphagia, or difficulty swallowing, is a common consequence of stroke, with incidences reported to be between 37–78% of adults post-stroke (Martino, Foley, Bhogal, Diamant, Speechley, & Teasell, 2005). There is concern that individuals with dys- phagia may be at risk of malnutrition and dehydra- tion as a result of decreased food and fluid intake (Foley, Martin, Salter, & Teasell, 2009). Malnutri- tion and dehydration have an enormous impact on physical and cognitive function, recovery, and qual- ity-of-life, with greater susceptibility to low blood pressure, falls, pressure ulcers, infection, and organ failure (Weinberg, Minaker, & American Medical Association Council on Scientific Affairs, 1995). Furthermore, dehydration has a known negative impact on hospitalization rates, length of stay, and ultimately on healthcare costs (American Medical Directors Association, 2001, Reviewed 2007). Fol- lowing stroke, dehydration may affect the ischaemic penumbra, induce neurological deterioration, influ- ence the evolution of the stroke itself (Britton, de Faire, & Helmers, 1980), and is strongly associated with an increased risk of venous thromboembolism (Kelly, Hunt, Lewis, Swaminathan, Moody, & Seed, 2004), and stroke mortality (Bhalla, Sankaralingam, Dundas, Swaminathan, & Wolfe, 2000). Correspondence: Jo Murray, Speech Pathology and Audiology, Faculty of Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. Email: jo.murray@health.sa.gov.au International Journal of Speech-Language Pathology, 2013; Early Online: 1–9 ISSN 1754-9507 print/ISSN 1754-9515 online © 2013 The Speech Pathology Association of Australia Limited Published by Informa UK, Ltd. DOI: 10.3109/17549507.2013.830776 Intake of thickened liquids by hospitalized adults with dysphagia after stroke JO MURRAY 1,2 , MICHELLE MILLER 1 , SEBASTIAN DOELTGEN 1 & INGRID SCHOLTEN 1 1 Faculty of Health Sciences, Flinders University, Adelaide, Australia, and 2 Hampstead Rehabilitation Centre, Adelaide, Australia Abstract There is widespread concern that individuals with dysphagia as a result of stroke do not drink enough fluids when they are prescribed thickened liquids. This paper details a retrospective audit of thickened liquid consumption of 69 individuals with dysphagia following stroke in acute and rehabilitation hospitals in Adelaide, South Australia. Hospitalized individuals with dysphagia following stroke drank a mean of 781 ml (SD = 507 ml) of prescribed thickened liquids per day, significantly less in the acute setting (M = 519 ml, SD = 305 ml) than in the rehabilitation setting (M = 1274 ml, SD = 442 ml) (t(67) = -8.34, p  .001). This daily intake of thickened liquids was lower than recommended standards of fluid intake for hospitalized adults. Fluid intake could be increased with definitive protocols for the provision and monitoring of consumption of thickened liquids, by offering more fluid via food or free water protocols or by routine use of non-oral supplementary routes. Future research into the effectiveness of such recommendations needs to evaluate not only the impact on fluid intake but also on health outcomes. Keywords: Deglutition disorders, fluid intake, thickened liquids, stroke, dehydration. Int J Speech Lang Pathol Downloaded from informahealthcare.com by Flinders University of South Australia on 06/25/14 For personal use only.