Rich Food for Individuals with Swallowing Difficulties

Opportunities & Challenges of Texture-Modified Foods.

Adjustments of textures, consistencies, or flow rates help individuals with swallowing disorders on the path to enjoyable eating and drinking. But what exactly does “soft diet” or “lightly thickened” mean?

Simon Sollereder & Wolfgang Staubmann

September 24, 2023

The right consistency with a good taste experience.

There is the possibility to provide individuals with swallowing difficulties with a somewhat everyday experience despite difficulties in eating. Depending on the need, foods and drinks can be modified in their texture and "bite" to make them still enjoyable to swallow, even with swallowing difficulties. Solid foods can be pureed or blended, and liquids can be thickened with thickeners. It is important not to make these consistency changes arbitrarily and unsystematically. Changes in consistency often also affect the taste experience or lead to the unintended avoidance of food. There is a significant risk that the person may choke or that residues in the throat may remain and not be swallowed, especially with too sticky foods. This should be avoided at all costs.

Uniform international consistency standards

So that the degrees of consistency adjustments are independent of the care setting, location, or caregiver, a global initiative regarding swallowing disorders developed in 2013 to create comparable standards: Whether a patient is being cared for in an acute hospital in Vienna, a rehabilitation center in Styria, or a nursing home in Tyrol, the terminology and assessment methods must be identical and comparable. This is the goal of the International Dysphagia Diet Standardisation Initiative (IDDSI). It aims to establish a uniform system for describing and providing texture-modified diets. The basic structure of the International Dysphagia Diet Standardisation Initiative enables interdisciplinary consensus-based and evidence-based testing techniques, as well as categorization of texture-modified food and beverage levels for patients with swallowing disorders in both clinical and non-clinical settings. IDDSI thus provides a common language for all those involved in dysphagia management.

The highest goal for the development of this project is patient safety

The standardization of food or liquid consistencies ensures a common international 8-level scale (0-7) with licensed definitions, numerical and color coding, and controlled translations (see Fig. 1). Through simple and traceable tests to determine consistencies (e.g., IDDSI flow test, spoon-tilt test, or fork-pressure test), IDDSI enables standardized and evidence-based testing and preparation of food consistencies in clinical practice. This is an important step toward worldwide consistent communication and the use of the same terminology and standards. IDDSI is already in the process of implementation in more than 40 countries, including Austria.

Porridge & Puree - Is it necessary?

When the consistency of food or liquids is adjusted to optimize the swallowing process, the appearance of the food often suffers: blending can cause the foods to lose their original shape and they are no longer easily recognizable as such. But "we eat with our eyes" - that's why there are ways to bring them back into "shape." This allows the food to be presented and enjoyed in a more everyday manner.

Nutrients and energy value

In addition to enjoyment, texture-modified diets also consider the available nutrients such as protein and calories. People with swallowing difficulties often tend to eat less, understandably having a reduced appetite. Consequently, they may unintentionally consume insufficient nutrients and energy, leading to unwanted weight loss and physical weakness, which can increase the risk of falling. For this reason, it is often advisable to fortify texture-modified foods with additional energy (calories) and protein, so that even smaller portions can provide an adequate amount of energy and protein. Maintaining good nutritional status is essential for feeling fit and strong.

Natural ways to increase energy content include using more oil or butter, as well as heavy cream and crème fraiche. Additional protein can be incorporated using milk or heavy cream, soups thickened with eggs, as well as cottage cheese blends and milkshakes.

We thank the authors for the contribution!

Further information about IDDSI: http://iddsi.org