Guiding Seniors Through Dysphagia Diets

This article on dysphagia diets was written by Pavneet Kaur dietetic intern at Oregon Health Sciences University. Reviewed/edited by Katie Dodd, MS, RDN, CSG, LD, FAND

DISCLAIMER: Consult with your doctor if you have any issues with swallowing. Further tested and evaluation may be needed. Note that dysphagia diets are recommended by speech therapists following a formal swallow study. All dysphagia diets are recommended based on an individuals’ needs.

Why the Need For Dysphagia Diets?

Dysphagia, or difficulty swallowing foods and liquids, can result from various underlying diseases. It can be painful and even dangerous.

So how does this effect older adults? Body functions such as swallowing can be impaired with increasing age and age-related diseases-resulting in more time and effort with eating.

Being on a diet designed to help people who have difficulty swallowing can greatly assist in easing the difficulties with dysphagia. However, it is important to receive proper diagnosis first.

Swallowing Difficulties

So, what does difficulty swallowing exactly mean?

Coughing or gagging while swallowing, losing weight, having pain while trying to swallow or being completing unable to, having frequent heartburn, drooling, and regurgitation are all symptoms of dysphagia (1).

Now, swallowing difficulties can lead to further problems such as:

• Malnutrition, weight loss, and dehydration
• Choking
• Aspiration pneumonia

Proper testing and diagnosing is important to determine the cause of the swallowing difficulty. Your doctor and medical team can help you determine if a dysphagia diet might be ideal for you. The good part is-being on a dysphagia diet can significantly help to reduce the complications listed above!

Aspiration Pneumonia

Aspiration pneumonia is a complication that can occur due to dysphagia. This occurs when food or liquids get into the lungs, which can cause a lung infection (1).

Older adults who have difficulty swallowing can reduce their risk of this compilation by following the dysphagia diets recommended by their medical team and practicing good oral hygiene.

Types of Dysphagia Diets

Being on a dysphagia diet can help to maintain a healthy weight, hydration, and nutritional status for older adults who have difficulty swallowing. So what types of dysphagia diets are out there?

The National Dysphagia Diet is the standardized diet tool that has been used in the US for quite some time.

Newer guidelines have been released focusing on standardization internationally. The International Dysphagia Diet Standardization Initiative (IDDSI) has created common terminology to be used across international borders to help those who have difficulty swallowing (3).

Different healthcare systems use different types of dysphagia diets. More are transitioning to use IDDSI.

National Dysphagia Diet

The National Dysphagia Diet is a standard diet designed for the treatment of swallowing difficulties and is separated into 3 levels (2).

Level 1: Pureed

First, level 1 of this diet consists of pureed food to a  smooth texture that is “pudding like.” These foods will require little chewing (2).

Level 2: Mechanical Altered

Next, level 2 of this diet includes foods that have a moist, soft consistency with mixed textures. Foods of this level should be in small ¼ pieces (2).

Level 3: Advanced

Finally, level 3 of this diet consist of foods that require chewing and soft foods. Mixed textures can be tolerated if they are not hard, sticky, or crunchy (2).

Thickened Liquids on the National Dysphagia Diet

Liquid diet definitions can be based on the thinness or thickness, which help to determine what level they fall under with dysphagia diets.

Nectar Thick liquids

These types of liquids will coat and drip off a spoon and can flow through a straw. It is internationally known as “slight thick” or “1” according to IDDSI (2).

Honey Thick Liquids

These liquids will have the consistency of actual honey and will flow off a spoon like a ribbon. It is harder to drink this type of liquid through a straw. It is internationally known as “mildly thick” or “2” according to IDDSI (2).

Pudding Thick Liquids

These liquids will stay on a spoon but won’t hold their shape as they will pour slowly off a spoon. The consistency will be sip-able and is internationally known as “moderately thick and liquidized” or “3” according to IDDSI (2).

IDDSI International Dysphagia Diet Standardization Initiative

The IDDSI provides a common terminology to describe food textures and drink thickness (3).

IDDSI Framework

IDDSI has a specific framework that lists foods and liquids at different consistency levels.

For foods these levels run from 3 to 7. For drinks these levels run from 0 to 4.

Note there is overlap in the levels for food and drinks (3).

Refer to the IDDSI website for additional information.

Testing Methods

If you need clarification when following the IDDSI framework, there are several food testing methods available to help you decide which foods and liquids would fit into what categories.

Fork Drip Test:

Used to check the thickness of level 3-5 foods depending on how they hold together on the prongs of a fork or how they flow through (3).

Spoon Tilt Test:

“Used to determine the stickiness of foods (adhesiveness) and the ability of the food to hold together (cohesiveness)” (3).

Fork/Spoon Pressure Test & Chopstick test:

Used to check the textures of foods in levels 4-7 a fork can be used to see how the food is changed when pressure is applied with the prongs of the fork or the back of the spoon (3). If these utensils are unavailable, chopsticks can be used to pick up and break apart the food to determine the consistencies and texture.

Flow Test:

This test can be used for examining drinks or liquidized foods using a 10 mL syringe to “classify drinks based on rate of flow” (3).

What To Do When a Dysphagia Diet Does Not Taste Appealing?

Now that we covered the basics, what if your dysphagia diet gets boring and bland? There are several techniques to elevate the taste of the food we eat!

Herbs/Spices

Herbs and spices can help to add flavor, taste, and color to your foods on a dysphagia diet!

For example: you can add basil, thyme, or parsley to soups and stews. Cinnamon, nutmeg, and pumpkin pie spice can be added to sweet dishes like applesauce or oatmeal. Garlic powder or black pepper can be added to mashed potatoes.

Sweeten Foods

Sweetening smoothies or milkshakes can be a great way to add more flavor! Adding chocolate syrup, caramel sauce, strawberry jams, and whipped cream can jazz up a milkshake!

For smoothies try adding coconut milk, maple syrup, mint, yogurt, or juice for freshness and flavor!

What To Do If You Can’t Prepare a Dysphagia Diet?

As older adults, it may be in your interest to find tips on preparing foods in alignment with the dysphagia diet. There are pre-made meals, meal delivery services, and caregivers can all assist you with your journey on this diet.

Pre-made Meals and Thickened Beverages

Pre-made meals and thickened beverages can help to ease time on food prepping and making! Having ready to go foods in the fridge or freezers make for a grab and go situation. You can find many pre-made meals or thickened liquids online.

Meal Delivery Services

Older adults have seen technology advance time and time again, and it can help to add ease to their life! Meal delivery services which can be found on websites and apps allow you to customize and pick which foods you want delivered to you! You can also have groceries delivered right to your door step as well as recipe handouts!

Caregivers

Despite these tips, you may just be looking for an extra set of hands that can help you prepare your meals and provide you with support.

Caregivers can ensure that you are meeting your dysphagia diet guidelines and can help you prepare, make, and store your food.

Following safe feeding and ensuring nutritional status can be monitored with the help of your caregiver.

What To Do If You Experience Weight Loss and Decreased Appetite?

Poor appetite can lead to weight loss, which can be experienced with those who have difficulty swallowing. Because eating can start to take more energy and effort, it can lead to a decrease in food intake as well as a desire to eat. But, there are many ways to deal with this besides adding flavor to your foods through herbs and spices!

Calorie Boosters

Calorie boosters are just what they sound like! High calorie foods can help to maintain weight and keep you satiated. Try using butter or cream cheese as spreads on sandwiches or accompanied with soups. Adding peanut butter or whole milk to shakes and smoothies can also help to add calories. Sour cream, cheese, yogurt, or using powders that increase calories can also be added to your meals!

Frequency of Meals and Snacks

Another tip to combating weight loss and decreased appetite is by increasing your frequency of your meals and snacks! You can have smaller amounts but more frequently throughout your day. This is a technique that helps to increase your appetite.

Speak To a Geriatric Dietitian

Speaking to a dietitian that specializes in geriatrics can help to offer a more focused approached towards your wellbeing as an older adult and provide the nutritional guidance you need on a dysphagia diet.

How Can a Geriatric Dietitian Help?

Having a geriatric dietitian your side can help to answer any specific questions you may have about your lifestyle with a dysphagia diet.

They can provide you with guidance on maintaining your nutritional health and weight, preventing aspiration pneumonia and other complications, as well as create specific meal plans for you that cater to your needs.

Individualized Plan to Optimize Intake

Do you have any specific problems you need guidance on? Maybe you prefer certain foods over others? Do you have trouble feeling satiated, getting in calories, or have a decreased appetite? A geriatric dietitian can help you combat all these problems and create an individualized eating plan for you that best suites you.

Guidance with Food and Liquid Choices

To prevent any nutrient deficiencies and chose the best food and liquids that add to your nutritional health, working with a geriatric dietitian can greatly enhance your experiences on this diet.

Strategies to Help With Weight Loss and Decreased Appetite

Lastly, any tips or tricks you need to help to maintain your weight and appetite, a geriatric dietitian would be your best friend! It is crucial to avoid further complications that come with swallowing difficulty and a dysphagia diet is a big change. It is important to have the guidance of a dietitian who specializes in geriatrics!

Conclusion

As we age, and our body changes, dysphagia can feel like an interference in our lives. Y0u are not alone and there are plenty of resources and tips on living on a dysphagia diet. Hopefully this article provided you with some of that!

References

1. “Dysphagia.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 17 Oct. 2019, mayoclinic.org/diseases-conditions/dysphagia/symptoms-causes/syc-20372028.
2. McCullough, G., Google Scholar More articles by this author, Pelletier, C., & Steele, C. (n.d.). National Dysphagia Diet: What to Swallow? Retrieved August 27, 2020, from https://leader.pubs.asha.org/doi/full/10.1044/leader.FTR3.08202003.16
3. International Dysphagia Diet Standardization Initiative. (n.d.). Retrieved August 27, 2020, from https://iddsi.org/framework/