Caring for those with swallowing difficulties

Introduction to dysphagia

There are a number of health conditions that can lead to dysphagia such as: dementia, stroke, Parkinson’s or post surgery. Usually we eat and drink without thinking about it. The normal swallowing process is controlled by nerves and muscles which ensure that the food in your mouth goes safely into your stomach.

If an individual is living with dysphagia, their swallow isn’t coordinated properly. So when needing to chew and swallow, this can be a delayed repsonse making eating and drinking a difficult process.

This can lead to food, fluids and saliva going down the wrong way, increasing the chance of choking, getting a chest infection and may even lead to pneumonia. The medical term for food or fluid going into your lungs is ‘aspiration’.

How we support the SALT team and individuals with swallowing difficulties and dysphagia

If our team suspect that someone living in our care home is having difficulty with swallowing, we will refer the individual for an assessment by a Speech and Language Therapist (SALT).

A resident may need to have a texture modified diet to support them to swallow safely. This will contain carefully selected foods of an appropriate consistency, which can be more easily managed by a person with dysphagia.  The texture of foods has specific descriptors used by professionals to describe texture modified diets. The descriptors used in the UK are covered by a framework called IDDSI Framework.

What is the IDDSI Framework?

The IDDSI Framework describes texture modified diets and has 5 levels of fluids and 5 levels of foods with levels 3 and 4 of fluids being the same consistency as levels 3 and 4 of food. The framework provides an agreed way of describing and testing food and drink suitability for those with swallowing difficulties.

In addition to texture modified diet foods, some individuals may benefit from fortified shakes in between meals, to help enhance their nutritional intake throughout the day.  We are able to add chocolate, banana or smooth fruit coulis, ice-cream and still follow the guidelines regarding thickness and consistency of the drink.

You can read more about the IDDSI Framework here.

Examples of IDDSI meals prepared by our chefs:

Supporting individuals with swallowing difficulties at mealtimes

Our chefs have been trained in texture modified diets and also have support from regional and central catering experts to ensure that our menu can be offered to those with swallowing difficulties.  We place a lot of importance on food and meals looking and tasting as delicious and appetising as possible within the IDDSI Framework.  Where we can, the food is piped, layered or moulded to look as close as possible to the original item on the plate.

Each resident has a Food Passport or Diet Notification Sheet, which is updated regularly. If gravy and sauces are requested by the resident, they need to be served at the same consistency as the meal, however on certain levels e.g. level 4 and 5 IDDSI, the gravy or sauce is added during the blending process.

Afternoon tea and snacks

Throughout our care homes, residents are offered afternoon team and snacks and this includes individuals following a texture modified diet. For those on IDDSI level 3 and 4, cakes and sponges can be pureed down with single cream in line with the guidelines and offered as part of our afternoon tea service. There are also techniques used that mean that whipped cream on cakes can be used to meet IDDSI level 4.

Essentially, afternoon tea and cake need not be missed. Our team can find a way of turning the cake or sweet treat into something that can be swallowed safely by each individual and also still look attractive.

Family support and health promotion

Helping families to understand the potential impact of swallowing difficulties is an important part of our current communications. Family members often bring in cake, treats or sandwiches for their relative not realising that this might create a choking incident. That said, families can sometimes spot early signs of swallowing difficulties and their feedback is welcomed by the team to help ensure the safety of the individual living in our home.

The chef team at each Four Seasons and brighterkind care home create a texture modified version of a sweet or savoury treat brought in by a family meaning that residents do not need to miss out on the slice of celebration cake or a ‘favourite food’.