When an aged care resident is experiencing swallowing issues, known as dysphagia, this can be a frightening time for the individual and their loved ones, with an escalated risk of choking and the need for a texture-modified diet to ensure their own safety. However, if insufficient knowledge is applied to meal planning and preparation, a modified diet can lead to malnutrition, dehydration, poor mealtime experiences and a reduced quality of life. This is where the right allied health support makes a big difference.
Upon discovering a resident is experiencing swallowing issues, referring to a speech pathologist is the first step, because every presentation of dysphagia and every resident is different. A speech pathologist will conduct comprehensive observations and swallowing function tests to identify the severity of the swallowing concerns. This will determine if the resident requires a texture-modified diet as per the International Dysphagia Diet Standardisation Initiative, commonly known as the IDDSI framework. The lower the IDDSI level, the fewer the available food options.
The next step is to introduce an experienced dietitian into the equation, who will assess the potential risk of malnutrition and observe other dietary risks in the context of those with dysphagia and prescribed texture-modified diets. In a person-centred approach, dietitians will work with residents to suggest foods and drinks that are appropriate to the diet, while aiming to maintain quality of life and meet nutrient requirements.
Texture-modified diets are foods or drinks that have been adjusted in texture and consistency to help individuals with swallowing disorders eat and drink safely. The different levels of texture-modified diets are carefully defined, following the IDDSI framework, which was created to provide an international standard for food and drink textures. Requirements are very exacting, such as the following considerations for spaghetti, based on each IDDSI level:
■ The ‘easy to chew’ level requires all vegetables to be peeled and cooked until tender, using smooth tomato puree so it is easy to chew.
■ The ‘soft and bite-sized level’ requires the use of minced meat and small pasta less than 1.5×1.5cm in size, such as orzo or risotto to make sure the food is soft and bite-sized.
■ The ‘minced and moist’ level requires the addition of extra pasta sauce to moisten the meal, and the use orzo or risotto pasta (less than 0.4×0.4cm in size).
■ The ‘pureed’ level requires the meat sauce and the pasta to be smooth, pureed and sieved separately.
While it is vital to engage with qualified, experienced speech pathologists and dietitians to help aged care providers comply with the texture-modified IDDSI levels for individuals, the value of consulting a dietitian in general menus cannot be underestimated. A good opportunity is during seasonal menu reviews, and menu and mealtime quality assessments. For people on texture-modified diets, keeping them engaged in mealtimes and the social interaction they offer is also important. There may be alternatives and substitutions of foods without completely changing the recipe, so everyone present at the dining table can enjoy the same flavours.
Not being able to enjoy the foods that someone is familiar with is not fun at all, especially when surrounded by friends and family who have greater options in foods to choose from. Dietitians who have extensive knowledge in food service and texture modified diets can understand how food can be altered or what other nutritious food can be substituted to allow individuals to have meals they are more likely to enjoy. Rather than limiting foods, a knowledgeable dietitian can find solutions that not only enhance quality of life but also provide nutritional adequacy.
Together, speech pathologists and dietitians work collectively to keep residents safe and enhance their quality of life. These health professionals are essential for the health and well-being of aged care residents, and for those residents with dysphagia, their expertise is vital.
OSCAR Care Group