Texture-modified foods and thickened fluids as used for individuals with dysphagia: Australian standardised labels and definitions.

Abstract

Thickened fluids and texture-modified foods are provided for the therapeutic treatment of dysphagia. Review of the literature indicated that numerous labels are applied to a small number of food textures and fluid thickness levels. The consequences of inconsistent terminology affect patient safety and the efficiency of communication. A joint project of the Dietitians Association of Australia and The Speech Pathology Association of Australia Limited (Speech Pathology Australia) was undertaken to develop consensus standards for number of levels, labels and definitions of thickened fluids and texture-modified foods within the Australian context. A project officer and multidisciplinary advisory committee were appointed by competitive process to carry out and oversee the project. The project determined that there were 39 different labels in use for thickened fluids and 95 different labels in use for texture-modified foods used in Australia. Dietitians and speech pathologists demonstrated overwhelming support for a standardised labelling and terminology system (99.2% of respondents). A national consultative process encompassing the views of more than 580 clinicians helped to formulate the final standards. A scale for modified fluids and a scale for texture-modified foods were developed and consensus was achieved between the Dietitians Association of Australia and Speech Pathology Australia. The standards are now recommended for use throughout Australia.

Key words: dysphagia diet, food and fluid standards, standardised diet, thickened fluid.

INTRODUCTION

Texture modification of foods and thickening of fluid forms a routine part of the assessment and treatment of swallowing difficulties (dysphagia). (1-6) Dysphagia contributes to reduced dietary intake, and potentially malnutrition, aspiration and asphyxiation. (7,8) Regular fluids require excellent muscle control and accurate timing between the swallowing system and the breathing system. Thickened fluids slow the act of swallowing and by doing so, enhance safe swallowing. (9) Modified diets use alterations to food texture to reduce the need to chew or orally prepare food. (10) When an individual has dysphagia, there is a breakdown in the swallowing process that can result in food or fluids entering the lungs (aspiration). If enough food or fluid is aspirated, severe infections such as aspiration pneumonia may develop leading to hospitalisation and even death. Consequently, thickened fluids and texture-modified foods is rarely a diet of choice, but a diet of necessity if an individual is to maintain their nutritional needs orally.

The provision of texture-modified foods and fluids is a prescription for individuals with dysphagia. By determining the cause and severity of the dysphagia, health professionals can determine the food texture and fluid thickness safest for an individual to swallow. If the prescription is not followed, the individual may face serious health consequences. Inconsistency in the labelling and definitions of foods and fluids adds an unnecessary and potentially dangerous layer of confusion. Confusion regarding food textures and labels was formally recorded as a contributing factor in the coroner's notes into the death of a South Australian nursing home resident. (11) To reduce the likelihood of adverse events, professional consensus on language for texture-modified foods and fluids is needed.

A lack of standard labels and definitions has a number of implications aside from patient safety. Comparison of research studies is difficult because of the lack of a common language for texture-modified foods and fluids. Research into the role of texture-modified foods and fluids in dysphagia management is an area needing greater focus to promote evidence-based practice. It is anticipated that national consensus on standardised terminology will provide a direct benefit to research in this area.