Navigating Dysphagia in Care Homes
Dysphagia is the clinical term for swallowing problems and can be linked to both eating and/or drinking. Issues with swallowing can be seen in various stages of the swallow including thepositioning of food in the mouth, chewing, moving food around the mouth, sucking, or in the general overall process of swallowing.
There are many clinical conditions that can lead to dysphagia. It is prevalent among certain groups of people (up to 78% of stroke residents, 80% of residents with head and neck cancer and up to 57% of people living with dementia) (1,2,3).
When we consider the wide range of conditions affecting people of all ages that can lead to dysphagia, we can see why it is so prevalent in care homes.
Dysphagia can have significant clinical implications on the individual and can lead to malnutrition, dehydration, impaired quality of life, choking, aspiration, pneumonia and in severe cases, death. Textured modified foods is one of the treatments available for managing dysphagia. The provision of the correct and most appropriate texture modified meals can provide a resident with a safe meal when they are clinically vulnerable and can promote resident-centred care and support their recovery by delivering vital nutrition.
Often, when someone needs to change their diet due to a clinical condition, in this case texture of diet (for safety reasons), there can be multiple emotional/psychological impacts including embarrassment of eating something different to others and dissatisfaction that food may look unappetising or unrecognisable. Dysphagia can compromise quality of life and create a nervousness around eating for the individual impacted.
For those living with dysphagia, the visual appeal of food cannot be over-estimated. It is essential to ‘dining with dignity’, and key to driving appetite.
‘Eating with our eyes’ is very important. The science is that sight of food provides our brains with sensory information that triggers our bodies physiological responses - for example, saliva production in the mouth, gut motility (which prepares our bodies to eat and drives appetite).
Texture modified foods are designed to replace meals that were previously blended into an unrecognisable meal. Provision of the correct and most appropriate TM meal can provide residents with a safe meal when they are clinically vulnerable, can promote resident-centred care, deliver vital nutrition and return dignity to dining.
IDDSI Framework and The Role of Texture Modified Food
Standardisation of texture modified food and fluids is assessed against the International Dysphagia Diet Standardisation Initiative (IDDSI) Framework, which replaced the old ‘National Descriptors’ in 2019 (4). The purpose of the framework is to promote common (international) terminology to describe food and fluid thickness levels and to define testing methods that can be done by anyone using standard kitchen equipment such as a spoon or fork
To describe food thickness, the following definitions apply:
• Level 3/Liquidised
• Level 4/Puréed
• Level 5/Minced & Moist
• Level 6/Soft & Bite Sized
• Level 7/Easy to Chew
When considering the provision of texture modified food for residents with dysphagia; safety and assurance, choice and variety, cost, and nutrition are all key elements that need to be considered. Care home caterers have an important role to play in not only providing residents with the correct meal but in endeavouring to speak positively about texture modified food to those people who are living with dysphagia.
By using a pre-prepared solution, care homes can see a reduction in preparation time, plus as they are pre-blended there’s no bacterial risk from blending equipment and handling. These ready-made options are also IDDSI compliant, reducing the need to test texture and consistency of meals against the IDDSI guidelines.
apetito has an extensive range of meals suitable for use in care homes. We provide products in levels 3, 4, 5 and 6, and we also have a range of products that are tested against the criteria for Level 7 Easy to Chew. Each of our texture modified product ranges have options that meet the British Dietetic Association (BDA) criteria for energy dense (ED) and are designed to be higher in calories to support the nutritional needs of residents with dysphagia who are at risk of malnutrition or are already malnourished.
All apetito’s products comply with the BDA Nutrition and Hydration Digest (5), and we have a variety of tasty options from classics such as roast dinners, to curries and desserts – there are dishes that suit each and every preference.
Every resident should be able to dine with dignity and by using pre-prepared texture modified meals, care homes are able ensure that residents living with dysphagia can enjoy mealtimes without having to compromise on flavour, visual appeal and most importantly, safety
To find out more about apetito's texture modified range, please visit apetito.link/specialdiets
References
(1) Martino, et al. Stroke. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. 2005;36 (12): 2756–63.
(2)Sullivan P, Guildford A. Swallowing intervention in oncology. San Diego: Singular Publishing Group INC; 1999.
(3)Alagiakrishnan K, Bhanji RA, Kurian M. Evaluation and management of oropharyngeal dysphagia in different types of dementia: a systematic review. Arch Gerontol Geriatr. 2013 Jan-Feb;56(1):1-9.