Dysphagia – the growing issue that must not be overlooked

NACC image 2Dysphagia is prevalent in care homes across the UK and it is a growing problem. A condition that can affect anyone at any time of life, dysphagia primarily affects the elderly and according to NHS England, 60-75% of care home residents may experience difficulty or discomfort with swallowing.

People with dysphagia are at greater risk of malnutrition, dehydration, aspiration pneumonia and choking.  It is therefore potentially fatal to underestimate or ignore the condition.  However, as dysphagia is a not a medically-diagnosed disease but a secondary condition of other illnesses, not all cases of dysphagia are recognised.

It is absolutely crucial that care providers and caterers are aware of the warning signs of dysphagia and react appropriately. Coughing when eating, changes to menu choices and picking at food are all signals of dysphagia and anyone displaying such behaviour should be referred to a speech and language therapist, via the GP, for immediate assessment.

Dysphagia can be effectively managed with a texture-modified diet. This minimises the risk of choking, whilst, if executed correctly, ensuring each meal delivers NACC image 3enough nutrients.  Liquids should also be thickened where necessary. The speech and language therapist will prescribe the right meal plan for each individual.

The national dysphagia diet descriptors are the sector standard for texture modification. Depending on an individual’s needs, food will be prepared according to the four key descriptors – B: thin purée; C: thick purée; D: pre-mashed and E: fork mashable. The Care Quality Commission recommends that care homes have available the dysphagia diet textures C and E.

Dysphagia is not necessarily a life-long condition and the objective is to always, where possible, return an individual to a solid diet.

A real challenge for caterers is that the cooking methods used in texture modification escalate nutrient loss. For example, cooking food for longer to aid the blending process increases vitamin loss, with fibre also lost during blending.  Add to this the fact that older people often have a depressed diet and it becomes essential that nutrients are replaced in each dish. This is done by fortification – adding ingredients to enhance the nutritional value of a dish.

NACC image 5Chefs need to think carefully and nutritionally about the ingredients and methods used in texture modification. For example, when thinning food it is not just about adding a liquid.  It’s about adding a liquid that contains nutrients and much-needed calories, such as a stock or cream. And, when cooking and regenerating food, it is also imperative to remove all choking hazards, such as a formed skin or crust. The best methods are therefore poaching, braising and steaming, with grilling and roasting to be avoided.

Well-thought out presentation of texture-modified food is also important in order to protect a resident’s dignity and boost their appetite.  Reforming, piping and moulding food to look like the original dish will increase its appeal and naturally encourage eating.  After all, we eat with our eyes.

Supporting the care sector

The NACC is dedicated to ensuring everyone in care environments has access to good nutrition and hydration by supporting care caterers with up-to-date advice and guidance on core issues, including dysphagia. The national dysphagia diet descriptors and advice, for example, can be found on the NACC website, together with an inspiring recipe book on fortified meals. NACC Logo1

Annually, the NACC Training & Development Forum offers care caterers a valuable opportunity to increase their knowledge and gain a new perspective on all care catering considerations through new information, insight and debate. It also enables them to discuss challenges and solutions with peers from across the country.

This year the NACC Training & Development Forum takes place 5-7 October at the East Midlands Conference Centre. With an action-packed programme of expert speakers, culinary demonstrations, interactive workshops and supplier exhibition, it really is an unmissable event for everyone responsible for or associated with the provision of care catering.

Find out more at www.thenacc.co.uk

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