NOURISHED AGING TOOLKIT Dysphagia Education: Fluids
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A MESSAGE FROM SYSCO’S NUTRITION SERVICES TEAM Older adults, living within Long-Term Care or Retirement settings are at increased risk of swallowing difficulties and dysphagia. Both have an impactful influence on individual's overall health & well-being, along with quality of life. This resource will focus on dysphagia education, including practical tips to address and manage swallowing difficulties and dysphagia. This resource will focus on topics such as: • • •
Understanding Dysphagia Nutrition in Dysphagia Management The International Dysphagia Diet Standardisation Initiative (IDDSI)
Product suggestions are also included in the toolkit. Please reach out to your Sysco Sales Representative for more information. Note: The information provided within this toolkit are suggestions and should be implemented in consultation with a Registered Dietitian & Speech-Language Pathologist and in accordance with your home specific policies and your resident’s individual needs.
TABLE OF CONTENTS 2.
Message from Sysco's Nutrition Services Team
4.
Swallowing Difficulties & Dysphagia
5.
Dysphagia Management
7.
Thickened Fluid Terminology
8.
Fluids and Foods
9.
Resident Centered Care
10. International Dysphagia Diet Standardisation Initiative (IDDSI) 11. 5 Safe Swallow Strategies
DYSPHAGIA – SWALLOWING DIFFICULTIES What is Dysphagia? • •
Difficulties with chewing and/or swallowing fluids or foods Occurs when the passage of fluids or foods from the mouth to the stomach is delayed or hindered1
•
Dysphagia can occur when the muscles, nerves, or structures involved in swallowing are affected. Common causes include: • Head and neck surgery • Stroke, head trauma, or other neurological conditions
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Risk factors include: o Aging, including natural age-related changes in swallowing and esophageal function2 o Neurological diseases, such as dementia, Parkinson’s disease, and history of strokes2
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If untreated or ongoing, dysphagia can lead to complications, including3: o Choking incidents o Unintended weight loss o Malnutrition o Dehydration o Aspiration pneumonia, when fluids of foods enter the airway3
Signs and Symptoms of Dysphagia: • • • •
Poor mouth seal4 Audible throat clearing4 Coughing or changes in voice quality4 Inability to tolerate mixed consistencies4
• • • •
Avoiding certain beverages4 Prolonged fluid consumption4 Significant weight changes due to decreased fluid and food consumption4 Recurrent aspiration pneumonia5
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DYSPHAGIA MANAGEMENT Who is Involved? Dysphagia management in Long-Term Care & Retirement involves the Registered Dietitian, Dietary Team, Nursing Team, and/or Speech-Language Pathologist. •
Assessment may include: ✓ ✓ ✓ ✓ ✓ ✓ ✓
• •
Overall fluid intake (i.e. hydration status) Assess nutritional status and nutrient requirement Drinking abilities (i.e. level of assistance from staff) Need for adaptive aids (i.e. lidded/spout/nosey cups) Body and head positioning Drinking skills Compensation strategies to promote a safe swallow
Depending on the resident assessment and needs, a modified fluid consistency will be assigned to residents and will be reflective on resident diet orders. Why modify fluid consistency? Thicker fluids move more slowly through the mouth and throat, which provides additional time and more control to make swallowing safer.
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Support, supervision and other assistance will also be indicated on resident care plans.
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Examples include: • Appropriate seating and positioning • Requires assistive devices and level of assistance by team
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DYSPHAGIA MANAGEMENT Managing Fluid Consistencies •
Thickened fluids allow residents to control the flow of fluids in the mouth and throat to help minimize choking and prevent aspiration pneumonia7,8
•
The terminology used to describe fluid consistencies may differ between healthcare settings: Traditional Terminology o Regular o Nectar Thick o Honey Thick o Pudding Thick IDDSI (International Dysphagia Diet Standardisation Initiative) Framework Some healthcare settings have adopted IDDSI, which includes: o Level 0: Thin o Level 1: Slightly Thick o Level 2: Mildly Thick o Level 3: Moderately Thick o Level 4: Extremely Thick
•
Commercial thickeners or pre-thickened commercial products are available for dysphagia management
Speak to your Sysco Representative for a product list of available pre-thickened commercial products and commercial thickeners
DID YOU KNOW? Adding ice to a drink changes the thickness. As the ice melts, it adds thin liquid to the beverage, which may make it thinner than the prescribed IDDSI level.
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THICKENED FLUID TERMINOLOGY The following chart outlines the various terminology used to identify and describe fluid consistency or thickness. Traditional Terminology
IDDSI Terminology
Description
Regular Thin Fluids
Thin (Level 0)
• • •
Unmodified Flows like water2 Can drink with any type of cup or straw2
N/A
Slightly Thick (Level 1)
• • •
Commonly used in pediatrics2 Thicker than water2 Requires more effort to consume than regular fluids2
Nectar Thick Fluids
Mildly Thick (Level 2)
• •
Flows off a spoon2 Requires effort to consume through a straw2 Able to sip from cup2
• Honey Thick Fluids
Moderately Thick (Level 3)
• •
Pudding Thick Fluids
Extremely Thick (Level 4)
• •
Requires effort to consume through straw2 Able to consume from a cup2 Consume with a spoon2 Cannot consume through a cup or straw2
Note: While the current, common terminology can be transitioned to IDDSI fluid levels, please ensure prepared products and recipes are re-evaluated during the adoption of any IDDSI fluid levels. Please always reference IDDSI.org for up-to-date information.
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DYSPHAGIA Fluids & Foods What are Transitional Foods? •
Transitional foods are foods that start as one texture but change into another texture when moisture (e.g., saliva) is added or when a change in temperature occurs.
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Because of the texture change, it may not meet the prescribed IDDSI level.
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Examples include: • Ice cream and frozen desserts that melt into a liquid • Potato chips and corn chips that soften with saliva • Wafers and crackers that dissolve or break down rapidly • Jell-O and gelatin desserts start as a solid but quickly turn into a liquid in the mouth
Mixed Dual Consistency Foods •
Not all fluids come from beverages; many foods contain liquid (e.g., soups, cereal with milk) or release liquid during chewing (e.g., watermelon, oranges)
•
These foods require special consideration when following IDDSI recommendations. Work with your healthcare team and resident to determine the best fit.
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RESIDENT CENTERED CARE A resident’s diet order must be in line with their nutritional goals and preferences. A resident may decline thickened fluids due to: • • •
Unfavourable texture Taste alterations Not thirst quenching
Note: Resident safety is always priority, however resident specific needs may require strategies & solutions determined by the care team to improve resident intake & satisfaction
Frazier Water Protocol •
The Frazier water protocol is one method that may help decrease risk of dehydration for residents who dislike thickened fluids
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Enables prescreened residents to freely consume regular water prior to a meal/snacks and 30 minutes after food intake to ensure that residents will not aspirate on food particles10
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Small amounts of water (neutral pH) in the lungs can be absorbed quickly by the body and decrease risk of aspiration11
•
Frequent oral care is required to ensure resident safety10
The Frazier Water Protocol should be implemented in consultation with a Registered Dietitian & Speech Language Pathologist & in accordance with your home specific policies Dysphagia Education Toolkit 9
The International Dysphagia Diet Standardisation Initiative (IDDSI) What is the International Dysphagia Diet Standardisation Initiative (IDDSI)? The International Dysphagia Diet Standardisation Initiative includes “standardised terminology and descriptors for dysphagia diets that would meet the needs of individuals with dysphagia across the age span, across all care settings and across all cultures.”9
The IDDSI Framework & Testing Methods The IDDSI Framework outlines the standardised terminology and descriptors for all diet texture and fluid consistencies. The framework consists of a continuum of 8 levels; Level 0-4 measures fluid consistency and Level 3-7 measure diet textures9. Included in the IDDSI Framework are IDDSI Testing Methods: The Testing Methods are intended to confirm the flow or textural characteristics of a specific product at the time of testing.9
Benefits of adopting IDDSI: • • • •
Uses the same texture and thickness terminology across care settings internationally Helps healthcare providers communicate clearly Makes transitions between hospital, rehabilitation, long-term care, and home more seamless Supports safer eating and drinking for people with dysphagia
To learn more about the IDDSI Framework & Testing Methods, click here.
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SAFE SWALLOW STRATEGIES SITTING POSITION Position residents upright at 90° (or as close as possible in bed) with head at midline
REDUCE DISTRACTIONS Reduce distractions during meals, including TV; promote a calm environment
EATING & DRINKING PACE Ensure residents eat slowly, finish each swallow before the next bite, and stay upright for 30 minutes after meals
SUPERVISION & ASSISTANCE Ensure care plans are followed, correct diet orders are served and provide mealtime supervision for choking safety
ALTERNATE FOOD & DRINK Alternate bites of food with sips of liquid to help clear residue; use caution with residents at high risk of aspiration
Disclaimer: Always follow facility policies and consult the Dietitian, Speech-Language Pathologist (SLP), and medical team for individual resident care.
SYNERGY TECH SUITE Use integrated Foodservice software to support you & elevate your level of care! How Synergy Tech Suite®’s all-in-one foodservice technology can help you plan and deliver personalized diets and textures: Sysco's Nutrition Services Team of Nutrition Services Consultants, including Registered Dietitians and Nutrition Managers, understand that delivering personalized care and adhering to frameworks like IDDSI can be challenging– especially when you already have enough of your plate. That's why Synergy Tech Suite® is dedicated to providing solutions that make the complex, simpler.
Here are just a few of the ways Synergy Tech Suite® technology can help make implementing IDDSI in your community that much easier: • • •
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Create and manage IDDSI food textures and fluid consistency diet types Create texture and fluid modified recipes efficiently Create and manage Diet Order Tags specific to IDDSI levels so you can easily search recipes Comprehensive People Profiles and Connect Technology help keep your team up-to-date on any residents’ texture and diet requirements. If you want to standardize and simplify your menu planning process as you implement IDDSI, or learn more about the benefits of end-to-end technology to resident safety and satisfaction contact support@mealsuite.com
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