Modified Diet & Dysphagia
June 22, 2020
Modified Diet & Dysphagia
Very elderly people, especially those with dementia, sometimes forget how to perform activities of daily living, including normal chewing and swallowing.
A common problem among the elderly is coughing or choking because the food or liquid is entering the windpipe.
This is called aspiration, and if it happens frequently the person could be at risk of developing pneumonia.
Serious swallowing problems can also occur with Parkinson’s disease and other neurological conditions, reflux disease, stroke, head or spinal cord injury, or cancer of the head, neck or esophagus.
What is dysphagia?
Dysphagia is the medical term for swallowing difficulties. Some people with dysphagia have problems swallowing certain foods or liquids or cannot swallow at all.
Signs of dysphagia includes: persistent drooling of saliva; coughing or choking when eating or drinking; being unable to chew food properly; bringing food back up sometimes through the nose; feeling that food is stuck in the throat or chest; a ‘gurgled’ wet sounding voice when eating or drinking.
Dysphagia can affect the quality of life because it may prevent from enjoying meals and social occasions.
Dysphagia can be improved but cure is not always possible.
Treatments includes changing the consistency of food and liquids to make it safer to swallow; speech and language therapy; other forms of feeding; surgery to widen the oesophagus.
What is causing dysphagia?
Dysphagia is caused mostly by another health condition. The condition that affects the nervous system such as stroke, head injury, MS, dementia; mouth cancer or oesophageal cancer; GORD (gastro-oesophageal reflux disease).
What modified diet means?
Modified diet will contain carefully selected foods of an appropriate consistency which can be more easily chewed and managed by a person with dysphagia.
There are few types of the modified diet with the different consistency.
After seeing the specialist (speech and language therapist/speech pathologist) you will be advised what type of diet will be appropriate for you.
Modified diet includes modified drinks and the food.
Reducing swallowing problems by making liquids thicker
Thicken drinks are normal drinks that have a thickener added to make them thicker. They are often recommended for people who can no longer swallow fluids safely, because drinks go into their lungs, causing coughing, choking or more serious risks such as a chest infection and aspiration pneumonia.
Drink thickness/textures are starting from:
- Mildly thick – fluid runs freely off the spoon but leaves a mild coating on the spoon, the consistency of nectar
- Moderately thick – fluid slowly drips in dollops off the end of the spoon, the consistency of gravy, honey, or milk shake
- Extremely thick - fluid sits on the spoon and does not flow off it, the consistency of custard or pudding
Thicker liquids travel more slowly down the throat and that makes them easier to control. Thickened drinks move more slowly, giving the body more time to control and giving the body more time to control and direct the fluid toward the stomach.
The thickness/consistency of the fluids will be advised by speech and language therapist/speech pathologist after the assessment, to prepare the right consistency.
To make the liquid of the right thickness you will be using powder or gel thickeners.
There are three types of modified diet:
- Soft / Texture A – food may be naturally soft or may be cooked or cut to alter its texture; can be chewed with minimal effort. Food should be easily broken up with a fork or be served cut up to a target maximum particle size of 1.5 x 1.5 cm. Food should be moist or served with a sauce or gravy to increase moisture content.
- Minced and Moist/ Texture B – this food texture includes foods which are very soft and moist and require only minimal chewing. The foods should be easily mashed up by a fork and may contain soft and round lumps (but no hard or sharp lumps). Food in this texture should be broken into pieces no bigger than 0.5 x 0.5 cm.
- Smooth puree/Texture C – food is smooth, moist, and lump free; may have a grainy quality. It does not require chewing. It cannot be poured, it does not ‘spread out’ if spilled. It can be eaten with a fork because it does not fall through the prongs.
The other factors that risk of choking or aspiration are:
- Increased amount of medication and person might be drowsy and not able to chew the food properly
- Person has slurred or unclear speech
- Excessive amount of saliva
- Poor dentition or dentures are not fitted properly
- Poor physical health
A texture modified diet will contain carefully selected foods of an appropriate consistency which can be more easily chewed and managed by a person with dysphagia.
Tips while having a drink and the food
- Have your meal in a quiet place
- Take your time when eating and drinking
- Reduce distractions such as turning off the TV when eating and drinking
- Sit upright during mealtimes, remain upright for at least 30 minutes after
- Do not talk while chewing or swallowing
- Swallow one mouthful before taking the next