The International Dysphagia Diet Standardisation Initiative (IDDSI) is now underway, with a goal to develop standardised terminology for texture modified foods and thickened liquids for people needing different forms of texture modification. The Dieticians Association Australia is one of many international supporters of the standardisation. For more detail on the initiative, read this.
Swallowing is a complex function we do both voluntarily and as an automatic reflex. When we eat, food is chewed, moved around in the mouth until it reaches a spot at the back of the tongue where our swallow reflex is triggered. This video animates what happens with dysphagia.
Speech Pathologist, Wendy Forster explains that for residents with Dysphagia, this process is impaired to some degree.
“The brain doesn’t register the normal sensory cues, so eating and drinking becomes a slow and difficult process,” Forster said.
Food and drinks need to be softened and thickened so they can be swallowed safely and with greater ease. Just as there are differing degrees of swallowing difficulty among people with dysphagia, there are different levels of texture modification needed to suit the individual.
The current Australian guidelines for texture modified foods is divided into 3 categories for liquid and 3 for food.
People with dysphagia need liquid such as juice, water or a cup of tea to be thickened so it can be drunk more slowly. This means using a thickening additive or substituting juice for nectar.
1) Mildly Thick:
Fluid runs freely off the spoon but leaves a mild coating on the spoon; the consistency of nectar.
2) Moderately Thick:
Fluid slowly drips in dollops off the end of the spoon; the consistency of gravy.
3) Extremely thick:
Fluid sits on the spoon and does not flow off it; the consistency of custard.
Food may be naturally soft or may be cooked or cut to alter its texture; can be chewed with minimal effort.
2) Minced and Moist:
Food is soft, moist and easily mashed with a fork; lumps are smooth and rounded.
3) Smooth Purée:
Food is smooth, moist and lump free; may have a grainy quality.
A speech pathologist will review the condition and request food be texture modified only to the level the person can safely manage, and no more. Enjoyment of food plays a big role in a person’s enjoyment of life, so losing a favourite food texture is especially hard. If a person enjoyed crispy roasted potatoes, suddenly only being able to eat a smooth puréed potato can be a huge blow, especially if they can still manage a soft texture.
Forster advises that all Aged Care Chefs know and adhere to the current guidelines and understand what they mean for residents. “A person’s level of texture modified food may change over time – upgraded or downgraded – so being aware of the resident’s current status is crucial.”
Forster cautions that assuming everyone needs the same level can become a problem. Over-modifying can be harmful. If the food doesn’t require any chewing it can move too quickly and may not trigger the swallow reflex correctly, even entering the person’s airways causing them to choke. Read more about Wendy Forster’s work with Dysphagia patients here.
Understanding the subtle but important differences in the way food and liquids should be modified is very important – for Chefs, residents, families and care staff alike.