Water Jelly Could Help With Aspiration Pneumonia in Older Patients

By Carolyn Crist

March 01, 2021

NEW YORK (Reuters Health) - Older patients who have moderate or severe dysphagia, or difficulty with swallowing, could benefit from using water jelly after meals to prevent aspiration issues, according to new findings from Japan.

Water jelly could also help patients who need to rehabilitate their swallowing and build up their endurance for common swallowing exercises, researchers write in the Journal of Clinical Gastroenterology.

"Water jelly can help with oral intake, and in some cases, prevent aspiration pneumonia," said Dr. Cathy Lazarus of the Icahn School of Medicine at Mount Sinai in New York City. Dr. Lazarus, who wasn't involved in the study, has researched strategies to manage swallowing disorders.

"There is evidence that a too-thickened liquid can increase the risk of aspiration pneumonia," she told Reuters Health by email. "However, the water jelly is thinner and likely would be just thick enough to prevent aspiration and assist in clearing residue from the pharynx."

Dr. Akira Horiuchi of Showa Inan General Hospital in Komagane and colleagues analyzed two studies that tested the efficacy of using water jelly for both prevention and rehabilitative purposes among patients with dysphagia.

In one study, 36 patients over age 70 underwent an endoscopic swallowing evaluation, after which 12 with a high dysphagia score were given water jelly three times per day (50 to 100 mL) to rehabilitate their swallowing. Those with a high score were expected to be able to eat pureed food after their rehabilitation on a feeding tube.

Overall, three of the 12 patients were able to eat a pureed diet and improve their caloric intake, as compared with zero patients who didn't receive the water jelly.

In a second study, 64 patients over age 70 were hospitalized due to aspiration pneumonia, and 34 were fed pureed rice with a gelling agent and treated with "cyclic ingestion" of water jelly after each meal to prevent newly developed cases of aspiration pneumonia.

Overall, two patients treated with cyclic ingestion of water jelly aspirated food, as compared with eight patients who didn't receive water jelly. In addition, no patients who were given water jelly developed new aspiration pneumonia, as compared with five patients who didn't receive water jelly.

"Taken together, the two studies . . . suggest that water jelly ingestion is a very useful strategy for both rehabilitation and prevention of aspiration pneumonia in elderly patients with moderate to severe dysphagia," the authors write.

Previous studies have shown that several factors play into the efficacy of gelatin-like ingestion materials, the team writes, such as hardness, cohesiveness and adhesiveness. Although little is known about the optimal characteristics for cyclic ingestion, the properties of water jelly may be useful to help older patients with swallowing, they note.

Simple repetition of swallowing could help patients to improve their swallowing functions, the researchers add. Water jelly could be safer and more effective than using plain water and could help build weak muscles. Using water jelly three times per day may create that repetition and help patients to build their endurance gradually.

A limitation of the two small studies is the sample size. Larger multi-center randomized trials are needed to confirm the effectiveness of using water jelly for rehabilitation and prevention of aspiration pneumonia for older patients with dysphagia, the authors write.

"The real bottom line is that water jelly is a compensatory strategy, and the true goal is to improve swallow function," Dr. Lazarus said. "Therefore, this is a good strategy to use while, hopefully, working on rehabilitating the patient's swallow function."

SOURCE: https://bit.ly/3tCOZb7 Journal of Clinical Gastroenterology, online January 19, 2021.