Dysphagia is the medical term used to describe swallowing difficulties.
Dysphagia (swallowing disorder) affects approximately 8% of the general population. This is 580 million people worldwide.
Dysphagia can result from a number of different medical conditions, such as:
- Parkinson’s disease
- Multiple Sclerosis
- Neurone disease
- Head and neck cancers
The disorder can range from minor difficulties with managing food and drink, to severe problems with swallowing.
It can occur when the muscles used for chewing and swallowing become weakened, or when there is a loss of coordination from the nerves that control them.
Dysphagia can also be caused by blockages such as a tumour.
Signs and Symptoms of Dysphagia
- Coughing and choking when swallowing food or drink
- Coughing fits during mealtimes
- Eating slower than usual and leaving food
- Food left in mouth following a meal
- Recurrent chest infections
- Weight loss
- A wet gurgling couch or voice after eating and/or drinking
Complications of Dysphagia
- Aspiration of food and fluid can lead to chest infections and develop into Pneumonia
- Increased stays in hospital, increased morbidity and mortality
- Malnutrition is common amongst people with swallowing problems
Dysphagia, Malnutrition and Dehydration
Eating and drinking difficulties can cause malnutrition and dehydration for a number of reasons.
- It may take much longer to finish a meal or a drink
- Coughing and choking can put people off eating and drinking, leading to a loss of appetite or desire to eat and drink
- Reduced nutritional intake. An average unfortified pureed diet contains only 800 calories per day
- Pureed food if not presented correctly can be very unappealing. The food can also be bland if consideration is not given to favours and if water has been used to puree the meal
An example of how a pureed meal should look. It is bad practice to blend all of the food together and serve people unidentifiable ‘mush’.
Blend pureed food with nutritious and fortified foods such as milk, cream, butter etc.
Altered texture diets can become boring and consequently can affect a person’s readiness to eat.
It is important to ensure that people on altered texture diets get the same variety as people who can eat and drink normally.
Dysphagia Diet Food Texture Descriptors
These were developed in 2011 by the National Patient Safety Agency.
For the purpose of this article, we will look at the existing descriptors.
B = Thin Puree Dysphagia Diet
- Food has been pureed and does not require chewing.
- Does not hold its shape on a plate and cannot be eaten with a fork.
- It is smooth with no ‘bits’ and therefore need sieving to ensure this.
- It is moist and any fluid on the plate needs to be as thick as the food itself.
C – Thick Puree Dysphagia Diet (may require a thickener)
- Food has been pureed and does not require chewing.
- Holds its shape on a plate and can be eaten with a fork.
- Must be smooth so any ‘bits’ must be sieved out.
- Again, any fluid on the plate should be as thick as the food itself.
D = Pre-mashed Dysphagia Diet
- Food is soft and moist.
- Needs very little chewing.
- The food should be mashed up with a fork prior to serving.
- Requires a very thick and smooth (non–pouring) sauce, gravy or custard.
E = Fork Mashable Dysphagia Diet
- Food is soft, tender and moist and needs some chewing.
- It can be mashed with a fork and again requires a thick and smooth sauce or gravy.
A speech and language therapist can assess people who are struggling to take fluids safely, without coughing and choking.
Thickened foods and fluids are easier to control when taken and this means that they can be swallowed safely.
Adding a thickener to fluids slows the liquid down when it enters the back of the throat.
This allows time for the swallow to be triggered. As a result, the airway is protected by stopping the liquid from entering it and ‘going down the wrong way’ as a result.
Fluids are generally separated into three levels of texture:
- Can be drunk from a cup as well as with a straw.
- It will leave a thin coating on the back of a spoon once mixed.
- Cannot be drunk through a straw but can still be drunk from a cup.
- Will leave a thick coating on the back of a spoon after mixing.
- Too thick to be drunk from a cup or with a straw.
- Taken with a spoon. Does not pour.
The guidelines for thickening fluids are from the National Descriptors for Texture Modification in Adults (2002).
Each brand of thickener is different. It is important to follow the manufacturer’s instructions carefully concerning amounts and also how to mix.
It is equally important to ensure that thickeners are stored appropriately.
Patient safety alerts were issued following a tragic case where a care home resident ingested thickening powder, which then formed a bolus and blocked their airway.
You can read the patient safety alert here.
Top Tips for Dysphagia Management
- Fortify pureed food, remember that the nutritional content is lower than regular meals
- Never use water to puree a meal
- Use moulds so that food can represent its natural state and therefore be more appealing to people
- It may be difficult for people on a modified diet to sit alongside people eating regular food.
Some people have described it as torture to sit watching others eat the food they can no longer have
- Keep snacks interesting as well as varied
- Follow manufacturer’s advice when thickening drinks
- Remake drinks left sitting for long periods
- If you think someone’s needs have changed, refer him or her back to Speech and Language Therapists for reassessment. This is just as important if someone has improved as deteriorated. Reassess anyone who may have improved, as a result, it may be possible for them to take regular food and drinks again
- Store thickening powders safely and also out of the reach of people who may ingest them