Swallow disorders, such as Dysphagia, increases the risk of choking, aspiration of food/fluids into the lungs and aspiration pneumonia. A Speech Pathologist may alter and review the texture modified diets and fluids to a safe IDDSI level depending on the individual’s capability. Dysphagia can also lead to malnutrition, dehydration, poor mealtime experiences and a reduced quality of life. This is where the help of an experienced Dietitian can help Residents on texture modified diets meet their nutritional needs.
Speech Pathologists will recommend seeing a Dietitian for nutritional needs of residents on texture modified diets. Dietitians may identify that a swallowing assessment with a Speech Pathologist is recommended for a resident. Together, Speech Pathologists and Dietitians work collectively to keep residents safe while managing the risk of malnutrition.
What are ‘Texture Modified Diets’?
Texture Modified Diets are foods or drinks that have been adjusted in texture and consistency to help individuals with swallowing disorders eat and drink safely. The different levels of Texture Modified Diets follow The International Dysphagia Diet Standardisation Initiative or commonly known as IDDSI. Â The IDDSI framework was created to provide an international standard for food and drink textures. Â
The IDDSI Levels for food and drink are:
Regular Diet (Level 7)
Regular diet – easy to chew (Level 7)
Soft and bite sized (Level 6)
Minced and moist (Level 5)
Pureed (Level 4)
Liquidised (Level 3)
Thin (Level 0)
Slightly thick (Level 1)
Mildly thick (Level 2)
Moderately thick (Level 3)
Extremely thick (Level 4)
When a resident is experiencing swallowing issues, referring to a Speech Pathologist is the first step. A Speech Pathologist will conduct comprehensive observations and swallowing function tests to determine the severity of the swallowing concerns. This will determine if the resident requires a texture modified diets as per the IDDSI Framework.
Unsure what the signs of Dysphagia are, download our Dysphagia checklist here.
How does a Dietitian help Aged Care Residents on texture modified diets?
Accredited Practising Dietitians (APD) provide evidenced-based dietary advice to minimise nutritional risks for those with swallowing issues.
Often for those who require a downgrade of the modified texture diet, they are at a greater risk of not achieving enough energy and protein, unplanned weight loss and dehydration as they are presented with limited options of food. That is when a Dietitian comes in to assess and provide individualised care plans to minimise these risks and promote a greater quality of life for residents.
Let’s find out more about how Dietitians help residents on texture modified diets, IDDSI and Dysphagia.
Dietitians working with Residents on Texture modified diets
Firstly, a Dietitian will assess the potential risk of malnutrition and observe other dietary risks in the context of those with dysphagia and prescribed modified texture diets.
Naturally, the lower of IDDSI level with food, the less options a resident may have to eat. Dietitians will work with residents to suggest foods and drinks that are appropriate to the diet, whilst providing enhanced quality of life and meeting nutrient requirements.
In most cases, those with dysphagia are also presented with other issues that may impact on eating such as loss of appetite, nausea and vomiting and increased energy and protein requirements due to illness. Cultural preferences may also impact the types of foods available on texture modified diets.
Ideally, a food first approach is recommended to promote food fortification strategies such as inclusion of foods high in energy and protein into meals. However, at times, this may not be appropriate, and oral nutritional supplements may be administered for increasing oral intake.
Textured modified diets and malnutrition
In addition to ensuring the food recommendations are appropriate for the texture modified diet, Dietitians will also consider the risk of malnutrition. Those who have dysphagia are at a higher risk of not meeting their nutritional needs, and in turn may lead to unintentional weight loss and/or subcutaneous loss of muscle and fat.
Physical assessments are conducted to determine whether individuals have signs of muscle or weight loss as this may then lead to higher risk of falls and weakness. Therefore, dietetic reviews are conducted to ensure nutritious snacks, foods and drinks are continuously offered to minimise the risk of weight loss.
Nutrition education sessions for textured modified diets
Understanding what foods and drinks are appropriate for each textured modified diet may be confusing as it requires great knowledge of foods, how to prepare it and how it interacts with the mouth prior to swallowing. Dietitians will educate the basics of food and what to look out for, as well as educating individuals, carers, support workers, family members, clinical and catering staff to look for nutritional adequacy, offering high energy and protein snacks, considering meal presentation, flavour, timing and frequency of food service and temperature.
Find out more about our Nutrition Education SessionsÂ
An important aspect of aged care menus is texture modification.
We Dietitians help you comply with the texture modified IDDSI levels on your Aged Care menus as well. During your seasonal menu review and Menu & Mealtime Quality Assessments, Dietitians will be reviewing the food on offer for the residents on texture modified diets. Â We strive to maintain choice for residents who may require modification. Â
In Aged Care, snacks are often provided for morning tea, afternoon tea and supper. Dietitians will recommend easy snacks that fit within all the IDDSI levels such as High Energy and High Protein chocolate mousse, or yoghurt.
Texture modification Aged Care Recipes
Speech Pathologists and experienced Dietitians may provide alternatives and substitution to foods without completely changing the recipe by simple swaps or recommending different cooking methods.
Below are some examples of how to adjust recipes (e.g. spaghetti) based on each IDDSI level:
Easy to chew – peel all vegetables, cook until tender, and use smooth tomato puree
Soft and bite sized – use minced meat and orzo pasta (<1.5x1.5cm)
Minced and moist – add extra pasta sauce to moisten, use orzo or risotto pasta (<0.4x0.4cm)
Pureed – puree and strain meat sauce and pasta separately
Each of OSCAR Care Group’s recipes contain suitability and modifications to suit all IDDSI food levels. Recipes are available to purchase individually, or in our upcoming Aged Care Recipe Book.
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The relationship between Dietitians and Speech Pathologists on texture modified diets
Upon any Speech Pathologists’ assessment, they may refer to a Dietitian if they determine if there is also a malnutrition risk or any issues with eating, foods or fluids or other nutrition-impacting symptoms.
Dietitians will refer to a Speech Pathologist if they have identified a choking hazard and further assessment and monitoring is required. Together, they may work in food service to determine what types of food can be modified, which thickening agent is appropriate for chefs to use, creating recipe ideas that is within texture requirements whilst achieving adequate nutrition.
At OSCAR Care Group, we have an amazing team of Aged Care Dietitians, Speech Pathologists and Chefs who working closely together to provide the best of care to residents, and amazing texture modified recipes. Find out more about our Allied Health team.
The advantages of having a Dietitian who understands texture modified diets
Not being able to enjoy the foods that someone is familiar with, is not fun at all, especially when surrounded by friends and family who have greater options in foods to choose from. Dietitians who have extensive knowledge in food service and texture modified diets can understand how food can be altered or what other nutritious food can be substituted to allow individuals to have meals they are more likely to enjoy. Rather than limiting foods, a knowledgeable Dietitian can find solutions that not only enhance quality of life but also provide nutritional adequacy.
Are all Dietitians trained in IDDSI?
No, but our Dietitians are.
Understanding texture modified diets is an extra step for Dietitians to further enhance their knowledge in IDDSI training, outside of university requirements. Therefore, not all Dietitians are trained in IDDSI.
Not to worry, with our OSCAR Care Group’s Aged Care Dietitians, they have been trained to know the difference between the IDDSI levels and provide education for those at nutritional risks. OSCAR Care Group have Dietitians who are trained to assess menus and provide recipes, and develop menus and recipes to suit all IDDSI levels, whilst working with Chefs and Speech Pathologists. We believe the more who know, the better the outcome for all with swallowing issues. This is why, we continue to train Dietetic work experience students, and have so over the years.
We’re here to help with Residents with dysphagia
Speech Pathologists and Dietitians are both allied health professionals that provide care for those who require texture modified diets. Speech Pathologists assess and determine the appropriate IDDSI level to minimise swallowing difficulties, while Dietitians ensure food provision adheres to the Speech Pathologist’s recommendations.
Together, they work as a team to ensure individuals, carers, support workers, clinical and catering staff are well educated and can provide correct dietary management whilst maintaining nutritional adequacy.
For more information on how our Dietitians can help and educate your Aged Care Home on Nutrition and Texture Modified Diets, please reach out to our team. To send a referral for a Speech Pathology or to organise IDDSI training, click here. Â