Modified Diets (IDDSI)

The International Dysphagia Diet Standardization Initiative (IDDSI) is a global standard with terminology and definitions to describe texture-modified foods and thickened liquids used for individuals with dysphagia of all ages, in all care settings, and for all cultures. The IDDSI allows healthcare professionals to help residents who need texture-modified foods and thickened liquids while ensuring that all care settings operate under the same guidelines (IDDSI.org).

Purpose: To reduce the risk of aspiration and it's consequences (e.g. choking, aspiration pneumonia, etc) (Reddacliff, 2022). For example, thickened liquids can be used to promote safer bolus transit and better airway protection (Joyce et al., 2015).

Population: Persons with dysphagia in various settings. The need for a modified diet is often guided by an instrumental assessment (e.g. videofluoroscopic swallowing study [VFSS]) (O'keefe, 2018).

While the use of modified diets to try to prevent aspiration in those with dysphagia has increased, there are potential hazards and disadvantages of modified diets that need to be considered along with careful patient consideration, including patient safety, goals, and quality of life (O'keefe, 2018).

Potential hazards and disadvantages of modified diets (O'keefe, 2018):

Poor hydration
Poor nutrition
Delayed medication absorption
Impact on quality of life
- O'keefe (2018) reports half to two thirds of dyspagia patients are non-compliant with recommendations to take a modified diet.
Caregiver perceptions
Costs associated
Inconsistencies in national standards and practices

Important considerations: Check adherence of diet through conversations and reporting from nurses, family members, and patient. Consider patient and family goals and care plan when making diet modification recommendations. Consider potential use of compensatory strategies to reduce risk of aspiration during mealtimes. Work closely with a dietician to ensure adequate nutrition.

dysphagiadiets.pdf

Dysphagia Diets

This resource explains levels of diet (e.g. purees, semi-solid, soft, and regular diets), a description of each, and examples of permitted and non-permitted foods. See the IDDSI classification and testing resource and consumer handouts for more information.

For example, the following is for purees:

IDDSI_Whole_Framework.pdf

Classification and Testing Resource

The IDDSI framework consists of a continuum of 8 levels (0 - 7). This resource explains each level, providing examples, and also describes how to test at each level (IDDSI.org).

Consumer_Handouts_for_Adults_All_Levels.pdf

IDDSI Consumer Handouts

"IDDSI has created these handouts in consultation with clinicians and patients. The handouts can be used by people who have feeding, chewing or swallowing problems, their caregivers and clinicians. There are separate handouts that have been designed for adults, and handouts that have been designed for use with babies and children. The handouts provide easy-to-read information about the IDDSI levels and their testing methods. The food levels also include examples of foods for each level, and food textures to avoid" (IDDSI.org).

CE_ManagingDysphagiaThroughDietModifications.pdf

Continuing Education

Managing Dysphagia Through Diet Modifications

This article describes normal and impaired swallowing and discusses types and levels of dietary modifications (Garcia & Chambers, 2010).

References
A global initiative to improve the lives of over 590 million people worldwide living with
dysphagia. IDDSI. (n.d.). Retrieved November 17, 2022, from https://www.iddsi.org/
Garcia, J. M., & Chambers, E. (2010). Managing dysphagia through diet modifications. AJN,
American Journal of Nursing, 110(11), 26–33.
https://doi.org/10.1097/01.naj.0000390519.83887.02.
Joyce, A., Robbins, J., & Hind, J. (2015). Nutrient intake from thickened beverages and
patient-specific implications for care. Nutrition in Clinical Practice, 30(3), 440-445.
O'Keeffe S. T. (2018). Use of modified diets to prevent aspiration in oropharyngeal
dysphagia: is current practice justified?. BMC geriatrics, 18(1), 167.
https://doi.org/10.1186/s12877-018-0839-7
Reddacliff, C., Hemsley, B., Smith, R., Dalton, S., Jones, S., Fitzpatrick, A., Given, F., Kelly, J., Lawson, X., Darcy, S., Debono, D.,
Benfer, K., & Balandin, S. (2022). Examining the content and outcomes of training in
dysphagia and mealtime management: A systematic review informing co-design of new
training. American Journal of Speech-Language Pathology, 31(3), 1535–1552.
https://doi.org/10.1044/2022_ajslp-21-00231.

Page updated

Report abuse