Dysphagia Care Chronicles: Navigating IDDSI in Long-Term Facilities
Navigating dysphagia care in long-term facilities can be complex, especially when it comes to ensuring individuals with swallowing difficulties receive appropriate diets. The International Dysphagia Diet Standardization Initiative (IDDSI) has transformed dysphagia diet management, providing a standardized framework for consistency and safety in healthcare settings. IDDSI categorizes food and drink textures into levels, simplifying communication and reducing the risk of choking or aspiration for individuals with dysphagia.
Level 0 - Thin Liquids: Often referred to as "regular" liquids, these are liquids that pour quickly, like water or juice. Some facilities still use the term “regular”, but IDDSI doesn't officially include it due to the variability in thickness.
Level 1 - Slightly Thick: The liquids in this category should have a thickness greater than water, ensuring individuals can effectively control the flow when using a straw. This viscosity should result in a slower flow rate. To assess, an IDDSI 10 ml flow test syringe should maintain 1-4 ml after 10 seconds.
Level 2 - Mildly Thick: Liquids should easily sippable, quickly pours from a spoon, and requires mild effort when consumed through a straw. To evaluate, an IDDSI 10 ml flow test syringe should retain 4-8 ml after 10 seconds.
Level 3 - Moderately Thick: This texture is appropriate for consumption from a cup or spoon, with the condition that it cannot be layered or molded. Its consistency must be smooth, without any lumps or fiber, and can include moderately thick soups or liquids with a nectar-like thickness. For evaluation, an IDDSI 10 ml flow test syringe should preserve more than 8 ml after 10 seconds.
Level 4 - Extremely Thick, puree: The most cohesive texture, typically used for individuals with severe swallowing difficulties. Eaten from a spoon, cannot be drank from a cup. No biting or chewing is required. Example of foods at this level, such as pudding or baby food. A spoon tilt test is suitable from this texture, little to no food should be left on the spoon
Level 5- Minced & Moist: Can be consumed using a fork or spoon, allowing for scooping or shaping, with no necessity for biting and requiring minimal chewing. Examples include finely minced meat, finely mashed fish, served with a sauce or gravy. Fruits and vegetables are recommended to be minced or chopped into pieces no longer than 15mm, with excess juice drained. Cereal and bread should be soaked in milk or any liquid, with surplus liquid removed before serving. Rice, couscous, and quinoa are suggested to be served with a smooth, mildly thickened sauce.
Level 6 – Soft & Bite Sized: Suitable for consumption with a fork, spoon, or chopstick, this texture can be broken-down using pressure from a fork; no knife is necessary for cutting. Biting is not obligatory, but chewing is necessary. The tender meat pieces should not exceed 1.5x1.5 cm, and fruits, vegetables, and bread should also be limited to dimensions not surpassing 1.5 cm. Bread is soaked until very moist, and rice is advised to be non-sticky.
Level 7 -Easy to Chew, Regular: Textures that are considered normal, soft, and tender are featured in this category, excluding seeds and fibrous fruits. Meat is cooked until tender, and fish is prepared to be soft. Casseroles are served in a mildly thick sauce, avoiding any hard lumps. The fruits recommended for this category should not have fibrous qualities, and vegetables are either steamed or boiled.
To gain a thorough understanding of dysphagia levels, healthcare professionals are advised to visit the IDDSI website. Implementing these levels in long-term care involves comprehensive assessment, collaboration among professionals, and staff training. It's crucial to tailor diets, considering preferences and swallowing abilities while ensuring safety. Regular assessments, education, and clear communication with residents, families, and caregivers are essential.
For thickening supplements, discussing appropriateness and ensuring proper communication with Speech therapists and nursing is crucial to achieve the desired consistency for individuals with higher nutritional needs.
References
International Dysphagia Diet Standardization Initiative (2019, July). Complete IDDSI framework detailed definitions 2.0.
https://iddsi.org/IDDSI/media/images/Complete_IDDSI_Framework_Final_31July2019.pdf
