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What patients and caregivers should know about diet, swallowing safety, and nutrition during their hospital stay.
A few years ago, Willie Mae Jones had a stroke in her sleep. She was 81 years old and living in a tiny town in rural Mississippi with her daughter Tedra. By the time Willie Mae got to the emergency department, the changes in her thinking and movement were already affecting how she fed herself and what she could safely eat. She spent the next few weeks in the hospital.
“My mom loved to talk, and now she couldn’t speak. The food part was hard. The hospital started feeding her soft foods and bubbly drinks to help her swallow safely. I had to learn to feed her, to find a balance. It couldn’t be too watery, but it had to be soft. I was afraid she would choke, even on water,” Tedra recalls. She finely crushed the crackers Willie Mae had always liked, as well as her medications, and fed them to her in little amounts on a small spoon.
Tedra carefully followed the medical nutrition therapy she observed in the hospital. She used bendable straws, learned how to mix thickener into beverages to prevent choking, and served spoonable choices like eggs, oatmeal, mashed pinto or black beans, and Willie Mae’s favorite ice cream: strawberry.
Not every hospital stay requires a special diet. Dieticians or speech-language pathologists will evaluate patients with neurological conditions or swallowing concerns soon after admission.
These professionals are key members of the hospital care team. Dieticians determine an individualized meal plan for appropriate calorie intake, heart health, diabetes, and other factors. A speech-language pathologist conducts a bedside test to check for choking risks, such as coughing while eating or drinking, explains Jessica Hooke, MA CCC-SLP, CBIS, MPH, a speech-language pathologist who specializes in stroke and other neurological conditions at Orlando Health Advanced Rehabilitation Institute.
“Different hospitals have different protocols. A nurse can [start with] a bedside swallowing test to determine if a patient needs a more formal assessment by a speech-language pathologist,” says Allison L. Weathers, MD, FAAN, a neurohospitalist and an associate chief medical information officer at Cleveland Clinic.
After the speech-language pathologist’s formal assessment, they may recommend a barium swallow test if the patient can sit up in a chair. The barium swallow test is video imaging read by a radiologist that provides more specific information than the bedside swallow test.
If the patient can’t do a bedside swallow test or if the barium swallow test results show that difficulty swallowing (or dysphagia) makes swallowing unsafe because of a risk of choking or aspiration (when food or liquid goes into the lungs), then the patient may need an alternative feeding option.
One option is a temporary nasogastric (NG) tube that is inserted into the stomach through the nose. The NG tube is different from a percutaneous endoscopic gastrostomy (PEG) tube, which is surgically inserted through the abdominal wall. If the patient cannot swallow but their digestive system is working, the doctor may surgically insert a PEG tube. Both tubes send food, fluids, and medicine directly into the stomach to give the patient the nutrition they need.
Read more: How Do Feeding Tubes Work?
In some cases, when a patient cannot swallow and their digestive system is no longer working, the hospital team will use total parenteral nutrition (TPN) to give the patient their essential nutrients intravenously, meaning through a vein.
If a patient is having trouble swallowing, the meal plan could include modified foods, thickened liquids, or both. The speech-language pathologist will follow the International Dysphagia Diet Standardisation Initiative (IDDSI) framework for patients who have trouble swallowing. The IDDSI framework uses a decreasing number scale from seven to zero to describe how thick drinks are and how soft or solid foods should be:
The IDDSI is used so that meals are prepared consistently in all hospitals across the world. Using the same levels everywhere helps patients, caregivers, and health professionals communicate clearly and avoid confusion.
“The family should be as engaged as possible early on,” says Hooke. “Watch how to thicken liquids. Note the size of the cut-up foods on the hospital tray. Ask about adaptive utensils. At home, eat with your loved one so they don’t feel isolated,” Hooke adds.
Patients with neurological conditions who are admitted to the hospital should try to keep their meal times and diet similar to their home routine.
“Keep things as stable as you can while you’re in the hospital, including medications and diet,” says Erin Presant, DO, movement disorder specialist at Central Coast Lifestyle Neurology Medical Group in Santa Barbara, CA.
It’s important to tell the hospital staff about the diet and mealtimes the patient follows at home so that they do not have any negative effects with their neurological condition. For example, some people with Parkinson’s disease eat six small meals daily to stave off nausea and constipation. Levodopa is the most common medication prescribed for Parkinson’s disease. However, “If it’s taken too close to a meal or snack containing protein, you won’t absorb as much of the medicine and it won’t work as well,” says Dr. Presant.
Hospital diets are designed to protect swallowing safety and support healing. Understanding why foods are modified and communicating needs and routines can help patients and caregivers work more confidently with dietitians and speech-language pathologists during an inpatient stay.
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