Cup VS Straw: Let’s get ready to rumble
It’s the match of a lifetime. In one corner, we have the tall and slim straw weighing in at next to nothing and in the other is the short and robust cup weighing in at whatever is put inside it. They have both been training (and researched) for years and are ready to go at it. Enough with the introductions, let’s get ready to rumble!
The Cup
Cups are your standard drinking device. Nothing exciting about them. But that may be their biggest strength. Patients have used them far more often than straws. Muscle memory plays an important factor here and instead of introducing a new utensil for liquid consumption, sticking to a familiar choice may be beneficial. Physiologically speaking, the cup may also provide a faster pharyngeal trigger as this study observed a delay with sequential straw sips which may lead to increased airway compromise. However, on the other hand, patients do tend to take larger and faster sips from the cup (vs straw), but this can be resolved very easily through the use of a Provale Cup.
The cup got a few good shots, but the straw isn’t down for the count. Let’s see what the straw can do with its back against the ropes...
The Straw Strikes Back
While an increased risk of airway compromise may be present with sequential straw sips, safety can be improved with smaller volumes which can be resolved easily if the patient can follow simple directions or by finding a straw with a smaller diameter (It’s easy to find all sorts of straws in all sorts of sizes and you can even use a straw version of the provale cup: SafeStraw). The straw dodged that hit, but can it go on the offensive? Yes! Here comes the straw with improved volume control and bolus containment. The straw also allows patients to drink with their head in the neutral head position which is safer and easier than the head extension normally used with sequential cup sips. The final blow comes as the straw allows patients to control their own volume of intake when needing somebody to feed them. Taking the variability of a feeder’s volume and speed out of the equation may reduce the risk of aspiration pneumonia.
The Cup Spilleth Over
This fight has been brutal. The cup coming in with some high hits and the straw has been able to dodge around them and offer some shots of its own. But who will be left standing after the last round? According to a recent study the cup had a higher score in the penetration-aspiration scale (PAS) (higher = worse) in 20 mL, 30 mL , and 40 mL trials. BUT the higher score was not statistically significant (womp womp). Further, the PAS continued to get higher with cup sips as the volumes increased, but stayed consistently low for straw sips. BUT again, not statistically significant. It does seem though that the volume taken from cup sips tends to be larger. This can be both good and bad. Good because increased volume could lead to improved ability to hydrate since our elderly patients are at increased risk of dehydration (20-30% water loss on average). Bad because 1. one is more likely to aspirate with larger volumes and 2. the mortality rate from aspiration pneumonia is dependent on the volume of aspiration. However, the straw doesn’t only allow for better control over volume. Remember, it also provides more control over the bolus itself: This study showed that elderly individuals were more likely to experience anterior loss in cup vs straw sips.
It looks like the cup is wobbling around and around ready to tip over. Let’s see what the judge has to say, shall we?
And the winner is...
The patient! While it seems at a quick glance that the straw has more benefits than the cup, we have to remember that everybody is different. There are benefits to both cup and straw use and given that the PAS scores don’t differ significantly, we can safely consider both options for our patients (as well as with modifications within those options such as the Provale Cup and SafeStraw). With an understanding of all the pros and cons, we can incorporate individual patient needs and preferences into our plan of care for that specific patient in front of us. Because they matter most. And what’s the best way to find out which utensil is best from a physiological perspective? You guessed it: An instrumental study. Without imaging, we only are guessing. So the instrumental study becomes the final and most important judge in the decision over this bout. But regardless, the decision that is made will be the one that is right for the patient. The true winner in this match.
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