1. NACC South East Christmas Seminar Dysphagia Diet Food Texture Descriptors
Caroline Lecko
Patient Safety Lead
NPSA/RCN

2. Aims
To provide a background to the development of the new descriptors
To discuss what’s different
To discuss why it’s important
To provide an update on the international position

3. Dysphagia Diet Food Descriptors
Launched in April 2011
Developed by:
NPSA
RCSLT
NNNG
HCA
Supported by:
NHS Supply Chain
Endorsed by the NACC August 2011
Engagement with industry

5. Why did we need new descriptors?
Original descriptors issued in 2002 by the BDA & RSCLT
BDA review document published in 2009
Recognised that there needed for engagement with industry and caterers
Compliance with National Descriptors for Texture Modification in Adults was poor
Requests from industry and caterers fro detailed guidance on categories of texture

6. Examples from the National Reporting and Learning System
patient requires soft moist diet . however soft options on menu not suitable as contains lumps . patient started to cough and choke . patient was asked to stop eating and rest for 30 minutes . patient recovered and to commence of puree diet
Patient was transferred to ward .... on .... , had been seen by colleagues and it was recommended she have a syrup consistency fluids and soft diet due to dysphagia . Went to review patient and found patient drinking normal fluids , with difficulty . Spoke to a nurse who informed that the recommendations had not been handed over , however the recommendations are recorded extensively in notes , including nurses entry immediately prior to transfer .
Pt previously assessed by SALT as requiring a Soft Grey Diet / meal arrived with boiled pots, whole peas & sweetcorn, should have been mashed pot, mushy peas & no sweetcorn.

7. What new? Endorsement from all of the key professional organisations
All care settings are required to have 2 available textures:
Texture C (Thick Puree Dysphagia Diet)
Texture E (Fork Mashable Dysphagia Diet)
Texture D ( Pre-mashed Dysphagia Diet) & Texture B (Thin Puree Dysphagia Diet) may be required in some care settings
Have been developed to include children

8. What does the new document include?
Specific standards for each texture B, C, D, & E
Audit checklists so that food can be measured can be measured against the standards for each texture

9. C Thick Puree Dysphagia Diet C C Thick Puree Dysphagia Diet C
For example
C Thick Puree Dysphagia Diet C
C Thick Puree Dysphagia Diet C
General description:
√ Food has been pureed or has a puree texture. It does not require chewing.
√ It is a thick puree*
√ It is smooth throughout with no ‘bits’ (no lumps, fibres, bits of shell/skin, bits of husk, particles of gristle/bone etc.) It may need to be sieved to achieve this.
Check before serving:
× No hard pieces, crust or skin have formed during cooking/heating/standing
× Fluid/gravy/sauce/custard in or on the food has not thinned out or separated off.
Note – definition of ‘thick’ puree
Holds its shape on a plate or when scooped.
Can be eaten with a fork because it does not
drop through the prongs.
Food has been pureed or has puree texture
Pass
Fail
Borderline
It does not require chewing
It is smooth throughout with no ‘bits’ (no lumps, fibres, bits of shell/skin, bits of husk, particles of gristle/bone, etc)
No hard pieces of crust have formed during cooking/heating
It has not thinned out and any liquid within the food has not separated off
Holds its shape on a plate or when scooped
Can be eaten with a fork because it does not drop through the prongs

10. Who are the descriptors for?
Primarily designed for food producers
Useful for staff teaching and training

11. So why is it important?

12. The risks – potentially life threatening
Malnutrition
Dehydration
Choking
Aspiration pneumonia
Death
Liquidised food and thickened drinks can be particularly unappealing with the potential to result in individual becoming malnourished and dehydrated.
An instruction for thickened fluids is viewed as ‘a prescription for dehydration’
Malnutrition is associated with the visual appearance and taste of the food, along with the fact that some texture modified food may also lack nutrient density.
Choking is considered the main complication of dysphagia caused by food going down the ‘wrong way’ potentially entering into the lungs causing infection and aspiration pneumonia.
All of these risks increase morbidity and mortaility.

13. Limited social activity Depression Anxiety Loneliness
The risks – quality of life
Low self-esteem
Embarrassment
Limited social activity
Depression
Anxiety
Loneliness
Loss of taste/smell

14. The role of food in the management of dysphagia
Impacts on both the potential life threatening risks and quality of life issues
Food needs to safe e.g. Meets the national guidelines for texture modification
Food needs to be nutritious e.g. Meets national guidelines
Reducing the risks associated with malnutrition, choking and aspiration pneumonia
There needs to be choice
Food needs to taste good
Foods needs to look good
We eat with our eyes and dysphagia does not affect your vision
Food needs be socially and culturally acceptable
All these things will improve someone’s quality of life.

15. 20 – 30% of patients within acute care
Dyphagia affects a lot of people
US – Dysphagia occurs in approximately 51% - 71% of patients with stroke and 75% of nursing home
More than 60,000 people die annually from complications related to dysphagia, making it the sixth leading cause of death in the US.
22% of the world’s population over 50 years old are affected by oropharyngeal dysphagia
20 – 30% of patients within acute care
59 – 60% of residents in care homes
Department of Veterans Affairs – Veterans Health Administration Directive 2006
Cook & Kahrilas 1999

16. 99% of children with severe cerebral palsy have dysphagia
> 900,000 people in England are living with the effects of stroke (NICE 2008). Of all those with dysphagia following stroke 76% will remain with severe and 15% profound dysphagia
200/100,000 UK population have dysphagia due to PD. More than 90% of those with MND will have dysphagia
RCSLT Resource Manual for Commissioning and Planning Services (2009)
There is also increasing recognition that Dysphagia is a symptom of concern in many other condition – head and neck cancer, acquired brain injury, cervical discectomy for example.

17. 68% of those with dementia in homes
27% of those with COPD
68% of those with dementia in homes
5.27% of all adults with LD were referred for advice regarding dysphagia
Between 50% - 75% of nursing home residents
10% of acutely hospitalised elderly

18. The Global Picture The Tango has just began ......
Potential for International Dysphagia Descriptors
Potential collaboration with interest from UK, Canada, Australia, Ireland, so far
Discussed at the European Society of Swallowing Disorders (ESSD) in September 2011
Watch this space