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ADULT SPEECH PATHOLOGY

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

PLANNING FOR IDDSI

The implementation date for IDDSI in Australia is 1 May 2019. Do you have a plan for implementation? Things to consider include:

  • Changes to policies and procedures
  • Changes to documentation
  • Training needs for care and food services staff

We recommend that you form a working party and have a look at the resources from the IDDSI website. There are some excellent implementation guides that will be of assistance.

SOFT AND BITE SIZED- Level 6 (Blue)

A Soft Diet and Bite Sized Diet may be recommended for a person who has difficulty biting, chewing and/ or swallowing some food consistencies, or for a person who tires easily from extended chewing throughout a meal.

Food in a Soft Diet is soft, tender and moist throughout, with no separate thin liquid. It can be easily broken up with a fork. The texture should resemble casserole, tinned peaches or boiled eggs. It should not be stringy, fibrous (like pineapple or celery) or have a tough skin (like capsicum, corn or chicken skins).

The Soft Diet must be cut-up into bite-sized pieces no greater than 1.5cm x 1.5cm for adults (or 8 mm for children). Some residents may not require their food to be cut up, but this must now be explicitly listed as an exception. The standard for this diet requires food cut-up into bite-sized pieces.

COLOURS and TESTING

There is a colour allocated to every IDDSI level. If you use colour coding in your kitchen then you will need to change to the new IDDSI colours. The companies making commercial thickened fluids or food will be transitioning to the new colours.

Every IDDSI consistency is described in detail on the IDDSI website. There is a testing procedure for each level of food and fluid so that you can assess whether the dish that you wish to serve is suitable for that particular diet. The main testing method for a soft diet uses a fork.

TESTING FOR A SOFT DIET

The fork should be pressed onto the food sample by placing the thumb on the bowl of the fork just below the prongs. The food sample should be squashed until the thumbnail blanches to white- this is the correct amount of pressure to apply. The food should easily squash and not return to the original shape when the pressure is released.

BREAD

Bread is NOT classed as a "soft" texture.

Bread is not included as part of a soft and bite sized diet. Bread is considered a regular food texture (Level 7) as it requires the ability to effectively bite and chew.

The ability to safely manage bread and sandwiches should be assessed on a case-by-case basis by a Speech Pathologist.

LEVELS OF SUPERVISION

For some individuals, a level of supervision may be required to ensure safe and/or adequate oral intake. Levels of supervision can be defined in various ways, however Adult Speech Pathology defines 3 levels of supervision as follows:

1:1 Supervision:

Sitting with the person and directly monitoring the individual throughout - maybe also providing full feeding assistance, assisting as needed or providing ongoing prompting.

Close Supervision:

In the same room as the person ready to intervene or assist as needed or if they are having issues.

Distant Supervision:

Monitoring regularly (e.g. if the person is eating in their room, ensure the door is open and check frequently). Ideally, you will be within earshot.

MALNUTRITION

Approximately 50% of individuals in an aged care home are malnourished or at risk of malnutrition. The reasons are numerous, with many having medical problems affecting requirements, loss of appetite, dementia and perhaps even dislike of the food. Residents who require a texture modified diet tend to be the most at risk of weight loss. They are often more unwell than those who do not need modification of their diet, but also the food can be unappetizing. We will discuss the presentation of the food in the next newsletter, but it is important to make every mouthful count. All texture modified foods should be fortified with protein and energy additions.

Protein is the nutrient that is needed the most, so encourage the meat, fish, chicken, egg portion of the meal in preference to 'eating all of the veges'. Add items such as milk, milk powder, egg, grated cheese, legume powders to boost protein in the small amount of food that is eaten.

Also use cream, oil, butter, margarine to add additional calories to the food. Use full fat dairy foods. If a resident prefers the dessert and refuses a main course, offer 2 desserts instead!

NOURISHING FLUIDS

A wide variety of nourishing drinks can be offered to boost intake for those who are eating poorly. Use a Food First approach and try out recipes for:

  • Milkshakes
  • Smoothies
  • Iced coffee
  • Hot chocolate
  • Fruit sherbet
  • Juices

Add a variety of ingredients- check with residents what they prefer. Develop a rotation so that there is something different every day. Get the Lifestyle staff involved in making a milkshake of the day.

Commercial supplements can also be useful- consult with your dietitian about when they should be used.

 MEAL PLANS FOR OLDER PEOPLE

Our new Meal Plans Manual is a bench top 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.

Read more

Resources for Aged Care

NPA has developed a set of resources and information for aged care homes.You can begin accessing  the NPA resources from our website now.

Read more

 

www.npagroup.com.au