'Dysphagia cup' encourages older people to drink more

An ergonomic, spill-proof cup that regulates the flow rate and reduce patients’ head tilt when drinking effectively reduces aspiration risk and increases fluid intake among its older adult users.

Designed by a team of researchers from Singapore, the ‘dysphagia cup’ is aimed at improving hydration among older inpatients who require assistance for drinking while minimizing workforce utilization. The cup features a nonslip base, a handle, a slanted wall, and a spill-proof spouted lid. This lid has an inner disc with outlets of different sizes that can be used with normal and thickened liquids as well as help adjust flow control.

The features are said to work to deliver liquid at a normal flow or restrict it to a small amount to allow older patients, including those with oropharyngeal dysphagia, to safely drink at their own pace, the team said.

Other notable features of the cup include a measuring gauge (to reduce the time needed to thicken fluids and increase the accuracy of measuring fluid intake and tracking hydration status) and dots over the holes on the disc (to facilitate identification among visually impaired caregivers).

Specifically, the measuring gauge “could potentially help reduce caregiver burden as it enables thickened fluids to be prepared in a shorter amount of time and reduces the need to repeatedly prepare the thickened fluid drinks,” according to the research team.

Drinking independently

In a pilot study that assessed whether the cup helped older patients meet their daily fluid allowance by at least 50 percent and nurses improve their productivity by 50 percent in terms of assisting patients with fluid intake, “the cup was able to meet all the expectations with good feedback from the care team, patients, and their families,” the researchers said.

The cup was issued to 20 patients from pilot wards at the Changi General Hospital. Total daily amount of fluid consumed improved by 62.25 percent over 16 months. The mean total daily fluid intake was 703.4 mL per day, with the volume consumed increasing by a mean of 269.8 mL from baseline. The types of fluid consumed per day included water, tea, coffee, sweetened drinks, fruit juices, and oral nutritional supplements. [BMJ Open Qual 2022;11:e002055]

Most patients (80 percent) were able to use the cup and drink without assistance. At 16 months, 75 percent of patients achieved an overall increase in fluid intake—a significant jump from the 11 percent who drank enough fluid to meet their recommended daily water allowance at baseline.

Freeing up nurses

Real-time data indicated significant savings in nurses’ time in terms of overseeing every step of fluid preparation for the patients, including thickening fluids, positioning the patients, encouraging them, and supervising them while drinking. Nursing productivity improved by 67 percent.

“Assuming the whole hospital of 1,000 beds had access to the dysphagia cup, with suitable patients given the cup to use, the hospital would be able to save 14.11 full-time equivalent of nursing workforce annually,” the researchers pointed out.

“With its increased ease of use, the cup also actively encourages patients to drink on and off during the day, in addition to giving patients the independence to drink on their own as the cup could be placed by the bedside,” they added.

The quality of patient care in institutions and hospitals may suffer from tight staffing coupled with busy work schedules. As such, the researchers believe that any workflow processes that help to increase productivity and save time will translate into better job satisfaction, reduced care burden, and better overall patient care.

Expanding userbase

The research team pointed out several challenges in the implementation of the use of dysphagia cup. These included the time taken to gain cooperation from the ward nurses, encouraging responsibility, maintaining adherence to the use of the cup, and gaining buy-in from patients and their families.

“Perhaps a video recording of the steps on washing, drying, and assembling the cup may save the care team’s time on caregiver training and can also be a source that patients’ families to refer to after discharge from the hospital,” they said.

One limitation of the study was its small sample size. The research team shared that they are already looking to involve the other wards in their hospital for more widespread use of the dysphagia cup.

“Moving forward, it would be prudent to continue to investigate and monitor the outcomes and implementation of the dysphagia cup to help ensure the sustainability of this project. It would be ideal to continue to expand the userbase … to improve generalizability,” the team said.

“Potential groups that may benefit from the cup include younger patients with neurological conditions (such as cerebral palsy and neurodegenerative disorders) and patients under the care of otorhinolaryngologists for oropharyngeal cancers with oropharyngeal dysphagia. The cup is also suitable for persons without dysphagia on thin fluids,” they added.