By Margaret Roche, MS, RD, CSG, CDCES, FAND
Dysphagia, or difficulty swallowing, is a disorder that may be caused by stroke, neurological disease, dementia, or other health conditions. Those with dysphagia require more time and effort to move food or liquid from the mouth to the stomach, which can make eating and drinking an unpleasant experience. People with dysphagia typically follow a diet of texture modified foods and thickened beverages, as maintaining proper nutrition can be difficult if proper care is not taken.
Each year, one in 25 adults experience a swallowing problem. Older adults are more likely to have dysphagia, including up to 68 percent of residents in long-term care. This is due to physical changes from aging that affect swallowing mechanics as well as a higher risk of conditions like stroke or Parkinson’s Disease.
Choking may occur when food gets stuck in the throat, blocking the airway. Aspiration pneumonia occurs from food or liquid entering the airway and bringing bacteria into the lungs. Difficulty swallowing can also make it harder to get adequate nourishment and fluids, resulting in malnutrition, weight loss and dehydration.
As a registered dietitian (RD) with more than 30 years of experience working with therapeutic diets, I have devoted significant time to understanding dysphagia and how to standardize modifications for food and beverages to remain safe and nutritious for patients with dysphagia. For those with dysphagia and their caregivers, here are seven tips to maintain proper nutrition with a dysphagia diet:
1Focus on safety: know the standards to get the consistency right.
Thickened drinks and texture modified foods make chewing and swallowing easier. IDDSI, or International Dysphagia Diet Standardization Initiative, provides a standardized, simplified way of naming, describing, and testing these texture modified foods and thickened liquids for people with dysphagia. The IDDSI levels correspond to varying needs of an individual’s chewing and swallowing capabilities, therefore becoming familiar with IDDSI and following each patient’s prescribed level will ensure the safest outcome.
2Learn the IDDSI testing methods.
A variety of quick and easy to complete tests (fork drip, spoon tilt, fork pressure, or syringe) ensure that the food being served is appropriate for a person’s needs. Below is a chart that outlines the IDDSI tests for each level.
3Focus on nutrient density.
Choosing nutrient-dense foods with high calories, protein and vitamins—such as fruits, vegetables, whole grains, fish, poultry, lean meats, eggs, and healthy fats—can ensure someone with dysphagia is getting the most out of every bite they are able to safely swallow. Eating small, frequent meals throughout the day and serving both hot and cold foods to provide variety to their diet can help as well.
4Rely on convenience.
Using ready-to-drink, commercially available pre-thickened beverages offers a safe and convenient solution to ensure you are serving your loved one or patient with dysphagia a safe and nutritious beverage, pre-thickened to their prescribed IDDSI level.
5Use thickeners and products specifically made for healthcare.
Make sure that foods and beverages are being thickened properly by using thickeners specifically created for dysphagia diets rather than at-home substitutes like potato flakes or flour. These standardized products have simple directions that get the appropriate food and drink consistency every time.
6Continue to celebrate with food.
The need for safety doesn’t mean someone with dysphagia needs to be excluded from events that involve eating and drinking regular foods. Socialization can greatly improve the eating experience for those with swallowing difficulties. To get comfortable with modified diets, start by eating at home with family and close friends. Enhance the appearance of modified foods by serving them in ways that are visually appealing, such as by using molds and piping or serving meals on attractive dishware. Try out different dysphagia-friendly recipes, such as mocktails or convenient puréed recipes. Adding new, delicious flavors can help as well, like thickened pineapple popsicles or thickened fruit punch drinks.
7Connect with SLPs and RDs.
Meeting with healthcare professionals can make it easier to live with dysphagia. Speech-language pathologists (SLPs) provide techniques to help with swallowing and offer ways to adjust to life after being diagnosed with dysphagia. Registered dietitians offer support and guidance on implementing a dysphagia diet, provide recommended foods to improve the dining experience, and can answer questions or concerns about meeting specific nutritional needs to prevent malnutrition.
Although dysphagia presents unique challenges, it can be easily managed with proper attention to safety and care during mealtimes. Start simple by following IDDSI testing and mixing up flavors and presentation at mealtime for those with dysphagia.
About the author
Margaret Roche, MS, RD, CSG, CDE, FAND is the founder of Roche Dietitians and a nationally recognized leader in nutrition for healthcare. A champion for senior nutrition, she advocates for quality improvement with texture-modified diets. Margaret has trained thousands on IDDSI implementation. Margaret’s opinions and advice are her own. Roche Dietitians has previously been compensated by Kent Precision Foods Group, Inc., producers of the Thick-It® brand family of products, for their research and industry insights.
American Speech-Language-Hearing Association. (n.d.). Adult Dysphagia. (Practice Portal). www.asha.org/Practice-Portal/Clinical-Topics/Adult-Dysphagia/.
Dysphagia. (2017, March 6). NIDCD. https://www.nidcd.nih.gov/health/dysphagia
Dysphagia – Diagnosis and treatment – Mayo Clinic. (2019, October 17). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/dysphagia/diagnosis-treatment/drc-20372033
Dysphagia-Friendly Summer Drink Roundup | Thick-It®. (2021, July 21). Thick-It. https://thickit.com/dysphagia-friendly-summer-drink-roundup/
How to Use. (2020, February 20). Thick-It. https://thickit.com/education/how-to-use/
IDDSI Framework. (2021). IDDSI.org. https://iddsi.org/Framework
IDDSI Testing Methods. (2021). IDDSI.org. https://iddsi.org/Testing-Methods
Purees Archives. (2021). Thick-It. https://thickit.com/category/purees/
Roche, M. (2021, May 18). Your Ultimate Guide to IDDSI. Roche Dietitians. https://www.rochedietitians.com/blog/2020/7/20/your-guide-to-iddsi-1