International Journal of Scientific Research and Engineering Development

Background: Dysphagia, impaired swallowing, is one of the most common and life-threatening complications in patients with dementia. It plays a vital role on Aspiration-related lung infection, dehydration, malfunction of nutrition and quality of life. TMDs and thickened liquids are routinely recommended for improving swallowing safety, but evidence supporting their long-term efficacy is inconclusive.
Objectives: This study aims to summarize the evidence regarding texture-modified foods and thickened liquids on reducing aspiration or pneumonia among older people with dementia. Secondary effects on hydration, nutrition and psychosocial well-being as well as the application of care are also assessed.
Methods: Systematic findings were performed in PubMed, Scopus, Embase, CINAHL Web of Science and Cochrane Library (2000–2025). Both randomized controlled, quasi-experimental, and cohort studies as well as qualitative designs were included if applied TMDs or thickened liquids in older adults (60+) with dementia-related dysphagia. Results were swallowing, aspiration rate pneumonia occurrence hydration nutritional status and qualice of life. The Cochrane Risk-of-Bias 2.0 tool and the Newcastle-Ottawa Scale were used to evaluate methodological quality.
Results: Twenty-seven studies were included (8 RCTs, 11 observational, 8 qualitative/mixed-method). Short-term evidence suggests that as the viscosity is increased, fewer aspiration events may be detected on instrumental assessments, in particular with honey-thick (≈3,000 cPs) and nectar-thick (≈300 cPs) fluids. However, the long term outcomes demonstrate bigger pneumonia numbers, increased dehydration and lower compliance with thickened fluids when compared to personal tailored swallowing strategies. There were a small number of occasions where you made texture-modified solid foods, these improved swallow safety; however, for some people they decreased appetite and enjoyment. Safety, compliance, and feeding outcomes were found to improve with the use of person-centred interventions and staff education.
Conclusions: Texture-modified foods and liquids can prevent immediate aspiration but not reliably the occurrence of pneumonia. They may also lead to detriments in hydration, nutrition and quality of life if not personalized. Interdisciplinary, evidence-based person-centered care unified with IDDSI standards is critical for quality dementia care.