Nutrition: Dysphagia — Following a Modified Diet
Dysphagia—a condition that affects so many people yet is rarely spoken about.
As one of the most commonly diagnosed swallowing disorders, dysphagia affects an estimated 9.4 million Americans. Each year, approximately 1 in 25 adults will experience a swallowing problem in the United States, and nearly one-half of people older than 60 will be affected by the disorder.
Several diseases and disorders, including stroke, Parkinson’s or Alzheimer’s disease, amyotrophic lateral sclerosis, multiple sclerosis, or even a brain or spinal cord injury, can affect one’s ability to swallow. Adding to the underlying disorder, dysphagia brings its own set of potential complications such as dehydration, malnourishment, and aspiration of food and liquids into the lungs.
Understanding how to create a modified diet for those with swallowing disorders is truly a matter of survival. When a person has dysphagia, their swallowing process does not function properly. Consuming texture-modified foods and thickened beverages allows more time for a successful swallow, which in turn can aid in proper nutrition and overall wellness.
The goal of a modified diet is to provide a safe, nutrient-rich mealtime experience for patients using foods and drinks that are easy to swallow, look appealing, and taste good.
A few important issues make adherence to a modified diet challenging for some. First, some of the food and beverage choices are unpalatable, and when taste and appearance are unappealing, one’s appetite can vanish. Coupled with that, many individuals with swallowing disorders are embarrassed by their condition. As a result, they opt to eat alone or rush through meals. Unfortunately, they often avoid eating altogether, which can lead to weight loss, malnutrition, and even depression.
These effects on confidence and dignity severely damage one’s quality of life. With recent innovation, this is changing. For example, the quality, versatility, and variety of products made for safer swallowing has improved immensely. There’s a greater focus on solutions that provide nutrition and health benefits and offer flavor, convenience, practicality, portability, and flexibility.
Further, professionals in our industry are making great strides in establishing common expectations for food and beverage characteristics through the International Dysphagia Diet Standardisation Initiative (IDDSI). This global effort to promote standardized, common-language terminology for texture-modified foods and thickened liquids aims to make dining safer and easier to administer for caregivers, patients, and manufacturers alike.
Navigating the challenges presented by dysphagia can be daunting. Consider the following tips:
• Learn to recognize the signs of someone who might be experiencing dysphagia, such as choking when eating, coughing or gagging when swallowing, pain while swallowing, or drooling, among others.
• Educate yourself on the products (such as prethickened beverages, purées, and food and beverage thickeners) that are available and how they can specifically help a patient suffering from dysphagia.
• Take time to understand a patient’s likes and dislikes to better determine the best menu options for them. When you have an understanding of what they like, it’s easier to customize a modified diet specifically for them—and it may increase their compliance with the modified diet, as well.
• Make sure that the products you recommend are IDDSI compliant. As the new guidelines are implemented (May 2019 was the US adoption date) by facilities, manufacturers, and organizations, it will be important to follow them for consistency across all food items.
• Explore professional resources for best practices, especially for encouraging consumption—adding warm bouillon made from thickened water to the dinner menu, or a frozen popsicle made from prethickened juice as an afternoon snack are just a few ideas from speech-language pathologists working closely with the dysphagia diet that help enhance intake and improve nutrition.
• Finally, mealtime and the ability to dine with dignity play an important role in a person’s mental health and quality of life. Taking the time to emotionally connect with those suffering from dysphagia is a critical step to ensuring patient compliance.
— Tom McGinness is a registered dietitian and regional sales manager for the Personal Nutrition Solutions (PNS) division of Kent Precision Foods Group, Inc. (KPFG). Under the PNS division, KPFG produces the Thick-It® brand family of products, which offers mealtime solutions to help improve quality of life for people with dysphagia as well as the health care professionals and loved ones caring for them. Thick-It® is a gold sponsor of IDDSI.