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Frazier Water Protocol

While it's a commonly held belief that aspiration of water is harmful, this is untrue. The Frazier Water Protocol (FWP) allows people with dysphagia free access to water with almost no incidence of aspiration pneumonia.


"Aspiration of water is a benign event; we've known that for quite some time," said Tom Franceschini, MS, CCC-SLP, coordinator of speech pathology and swallowing disorders at Hancock Regional Hospital in Greenfield, IN. "Over the years therapists have picked up on the idea that if a drop of water enters the lungs, the patient will die. We're not sure where that came from."


Unlike soda or coffee, water has a neutral pH level. Therefore, it is well tolerated by the lungs and is quickly absorbed into the bloodstream. Kathy Panther, MS, CCC-SLP, inpatient rehabilitation director at the Frazer Rehab Institute, Louisville, KY, developed the Frazier Water Protocol 22 years ago.


Prior to its development, the main concern was preventing aspiration pneumonia. The focus now has now shifted to preventing dehydration.


"Dehydration is probably one of the most misunderstood conditions by healthcare providers and the general public," Panther told ADVANCE. "The nutrition literature says that a large segment of the population is at least mildly dehydrated."


The fact that the Frazier Water Protocol combats dehydration is an unexpected side effect, she said.


Negative consequences of dehydration include changes in drug potency, trouble with healing from infections and wounds, urinary tract infections, constipation, confusion, lethargy, acute renal failure, and a malfunctioning cardiac system.


The aging process also plays a part in dehydration because older adults have a diminished sense of thirst.


"Elderly in nursing homes are chronically dehydrated, which has to do with the fact that they don't have access to liquids a lot of time," Franceschini said.


Other factors that contribute to the difficulty of older adults obtaining water are losses in mobility, dexterity and visual acuity, as well as communication and cognitive impairments. Some patients may avoid water because they are embarrassed by the fact that they need assistance to use the bathroom.

Frazier Water Protocol

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  Last Post: May 26, 2013 | View Comments(4)

Frazier water protocol has worked GREAT!!!! for my 98 1/2 year old aunt. She has been on it for over 3 years. we use a sippy cup for her water and there is little to no choking. I highly recommend this for any elderly with swallowing issues. Also she has had no incidents of pneumonia while on Frazier water protocol. And she does aspirate some of everything she swallows per the barium swallow test.

Terre May 26, 2013

The Frazier Free Water protocol has NOT worked on my Mom, because she will only take one sip of the thickened water or any of the thickened liquids. The nursing home has gone way overboard with this and now, has my Mom dehydrated and returned to the hospital. My Mom did NOT choke on clear liquids, nor clear liquids with food to begin with. I should know, since I have helped feed her on numerous occasions thoughout the last 3 years and 8 months.

Jan November 20, 2012
Muncie, IN

I'm assuming that thickened water is NOT neutral pH due to the thickening agent added?

Heidi Steien,  Speech-Language PathologistJanuary 13, 2010
Visalia, CA

Read all comments (4) >>


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