ADULT SPEECH PATHOLOGY

This newsletter is a joint collaboration between Adult Speech Pathology and Nutrition Professionals Australia.

REGULAR- EASY TO CHEW Level 7 (Black)

You will notice that the Framework at left is a little different to what you have seen previously. A new texture has been added for those without dysphagia or for individuals who do not have a risk of choking but who need softer foods.

Regular Level 7 now encompasses both the full "Regular" diet which includes normal everyday foods with no restrictions, a new IDDSI level- Regular level 7 : Easy to Chew. Easy to Chew foods include normal everyday foods of soft/tender texture.

REGULAR- EASY TO CHEW Level 7 (Black)

This diet texture may be appropriate for people who usually choose to eat soft food and have weaker chewing muscles for hard/firm textures, but can chew soft and tender food without tiring easily and are not at risk of choking.

People having this diet texture should be able to move food around their mouth for chewing and can apply pressure to the food until it is soft/moist enough to be easily swallowed. The person should be able to remove bone, gristle and other hard pieces that cannot be swallowed safely without needing help or prompting from others.

(c) The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/

TESTING METHODS

Any method may be used to eat these foods including fingers, fork, spoon, chopsticks etc. There is no food piece size restriction. 

DIFFERENCES- EASY TO CHEW vs SOFT AND BITE SIZED

Level 7 Easy to Chew           Level 6 Soft and Bite Sized

Normal every day foods of soft/ tender texture.

Soft, tender and moist with no thin liquid leaking/ dripping from food.                                                                           

Bread is assessed on an individual level by a speech pathologist. Check with your clinician for direct advice re bread ad sandwiches (and fillings) NO BREAD
No restriction on particle size. Must be bite sized lumps with particle size no larger than 1.5cm by 1.5cm.
May include mixed texture foods (thin and thick texture together). Ask the speech pathologist for more detail. NO mixed consistencies. No thin liquid leaking/ dripping for food.


 

TRANSITIONAL FOODS

Transitional foods are those that start as one texture (firm/solid) and change into another texture when moisture is added (e.g., water or saliva) or with temperature change (e.g., heating).

Biting is not required, and minimal chewing is needed. Tongue pressure can be used to break these foods after moisture/saliva or temperature has changed texture.

Transitional foods may be used to re-teach chewing skills (only in consultation with a speech pathologist).  Only serve food pieces in the size recommended by the speech pathologist.

TESTING FOR TRANSITIONAL FOODS

MIXED CONSISTENCIES

Mixed consistency foods include both solids and liquids (eg vegetables in a soup broth, or cereal with runny milk).  Generally, mixed consistency foods are considered a regular food texture (Level 7), and are not usually permitted on other food levels (unless individually tested and written as an exception by a speech pathologist).

In order to manage mixed consistencies, individuals need to be able to manage both components during oral preparation. Research has shown that while chewing the solid component, the liquid component of these foods spill into the pharynx and collect there (Saitih et al., 2007), and in some cases the liquid is swallowed first. To consume these foods safely, individuals require the ability to safely separate the liquid and solid components in the mouth, and this takes considerable oral skill to manipulate and control.  For people with dysphagia, this may represent an increased aspiration risk and a risk of choking. 

Gravies and casseroles must be not have a "thin" liquid sauce that separates. 

CATERING FOR A TEXTURE MODIFIED DIET

All menus must be planned to ensure that residents can take sufficient of all of the recommended food groups. This applies particularly to texture modified diets.

Soft, and minced and moist and pureed choices should be indicated on the menu. All 3 meals and 3 snacks must be considered. Texture modified items must follow the regular menu. Residents should be served the same (modified) items where possible. The items served at the evening meal must be different to those served at the lunch time meal.

A rotation for mid meal snacks should be developed. Pureed snacks must include: pureed fruit, custard, icecream, yoghurt as well as pureed cake or pudding with custard/ cream. Soft items must also be offered at all mid meals eg soft cake rather than regular sweet biscuits.

It is important to focus on protein items. Pureed meat is often 'diluted' with gravy and may have thickeners and potato added to enable the item to hold on the plate. This means that the amount of meat provided might be much less than the amount served to those on a regular diet.

The presentation of texture modified meals must be considered- molds are increasingly popular but there are numerous ways to improve presentation without using molds eg using attractive dishes/ piping foods etc.

IMPROVING NUTRITION in 2019

Our 2019 Improving Nutrition 2 day seminars are filling up fast. Our first program in Sydney will run on the 16th and 17th May. Save the dates.

See the website for more details and for the dates in your region.

This year we will be focussing on IDDSI and the new standards.

 MEAL PLANS FOR OLDER PEOPLE

Updated for IDDSI!

NPA's new Meal Plans Manual is a benchtop guide to nutrition care and therapeutic or special diets when catering for older people.

It provides a summary of nutrition for an older person, information regarding menu planning as well as a meal plan for each of the various special diets that are likely to be encountered. 

Many of these special diets eg diabetic and texture modified diets are routinely provided from the main menu, but others will need to be catered for on an individual basis.

The meal plans provide a simple and practical guide that can be readily referred to at the time of serving meals.

Also included in this manual is information regarding standard serve sizes and a standard menu structure to ensure that residents are provided with ample opportunities to choose foods from each of the core food groups and to ensure that the organisation meets Best Practice and/ or Accreditation Guidelines.

ONLINE RESOURCES

Online e-learning Presentations

Have you attended NPA's Improving Nutrition in Aged Care Seminar? We are now offering the seminars as a series of online e-learning presentations.

Also updated for IDDSI.

Read more

Resources for Aged Care

NPA has developed a set of resources and information for aged care homes.They have recently been upgraded- both the content and the look and feel of the resources.You can begin accessing them from our website now. 

Includes resources for IDDSI.

Read more

 

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