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Teachable Moment
Less Is More
June 2016

The Horrible Taste of Nectar and Honey—Inappropriate Use of Thickened Liquids in DementiaA Teachable Moment

Author Affiliations
  • 1Department of Internal Medicine, PRIME Residency Program, University of California and San Francisco Veterans Affairs Medical Center, San Francisco
JAMA Intern Med. 2016;176(6):735-736. doi:10.1001/jamainternmed.2016.1384

A woman in her 90s with advanced dementia was admitted for stage IV pressure ulcers. She lived at home with her son, who was her primary caregiver and surrogate decision maker. After a hip fracture 1 year prior, she became completely dependent on her son. Because of her dementia, she was started on honey-thickened liquids for aspiration prevention.

During the first week of hospitalization, she refused nearly all food and thickened liquids, turning her head when nurses attempted one-on-one feeding. By the end of the week, only her son was able to feed her small amounts of familiar foods. In consultation with the palliative care service, the primary team and son transitioned the patient to inpatient hospice. Her diet was liberalized to regular liquids and her favorite foods. Her intake improved. Two months later, she had gained 8 kg without enduring a clinically significant aspiration event.

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