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International Dysphagia Diet Standardisation Initiative: Survey results – An international snap shot of names and levels of thickened liquids and texture-modified foods
Julie A. Y. Cichero1 and Peter Lam2 1. School of Pharmacy, The University of Queensland, Australia; 2. Peter Lam Consulting, Vancouver, Canada
On behalf of the IDDSI Committee: Co-Chairs: Peter Lam (CAN) & Julie Cichero (AUS); Committee: Jianshe Chen (CHN), Roberto Dantas (BRA), Janice Duivestein (CAN), Ben Hanson (UK), Jun Kayashita (JPN), Caroline Lecko (UK), Joe Murray (USA), Mershen Pillay (ZAF), Soenke Stanchus (GER), Catriona Steele (CAN) Website: www.iddsi.org
Introduction Findings Summary
Method
• Food texture and liquid modification for dysphagia management occurs throughout the world.
• To date there are seven published national standards including: Australia, Denmark, Ireland, Japan, Sweden, UK and USA.
• The names, number of levels of modification and characteristics vary within and across countries.
• Multiple labels increase risks for patient safety. This study proposed to capture use of published and non-published names, levels of modification, and schemes used internationally to describe texture modified foods and thickened liquids used in dysphagia management.
• Four stakeholder surveys were developed using SurveyMonkeyTM and disseminated to the international community via the internet and contact with Professional Bodies or Associations
• The Information sheet was translated into 10 languages other than English
Responses were gathered from: 1. Patients, carers and organizations that support individuals
with dysphagia (n=86) 2. Health professionals (Dietitians, Speech Language
Pathologists, Occupational Therapists, Nurses) and Food Service Providers (n= 1901)
3. Dysphagia research scholars (n=32) 4. Industry (Food and Liquids, including providers of
thickening agents) (n=31)
Thickened liquids
• 27 different labels for up to 5 levels of liquid thickness
• 3+ levels of liquid thickness plus regular fluids most often reported
2049 responses from 33 different countries
Texture modified food
• 54 different labels for
up to 5 levels of food texture modification
• 4-5 levels of food texture modification plus regular food most often reported
• Considerable variation exists within and between countries and regions of the world
• Some terms are not understood by all cultures (e.g. pudding, mince, nectar)
• Some terms are problematic for specific populations. For example: In the pediatric population ‘bee honey’ is unsafe for infants due to botulism. Therefore, the term ‘honey’ was questioned as a safe label for thickness
• Fewer than 50% of health professionals checked that texture modified food or thickened liquids were of the correct consistency before serving
• Visual inspection or observation was the most common assessment method for determining correct food texture or liquid thickness
• Color coding was the most commonly used schema
Conclusions • There is enormous variation in terminology for
texture modified foods and thickened liquids used in dysphagia management around the world.
• There is substantial support for standardized international terminology.
• Color-coded, image-based and culturally neutral terms should be considered.
IDDSI Supporters: Dysphagia Research Society; National Foundation of Swallowing Disorders; Academy of
Nutrition + Dietetics; Africa Alzheimer’s Congress; American Speech-Language and Hearing Association; British Dietetic Association; Canadian Association of Occupational Therapists; Canadian Association of Speech-Language Pathologists and Audiologists, Dietitians Association of Australia; Dietitians of Canada; Lung Association of Australia; Speech-Language + Hearing Association of Singapore; Speech Pathology Australia;
World Congress of Healthy Ageing
IDDSI Sponsors
Tes$ng for correct
consistency before serving
Pa#ents/caregivers are more rigorous at tes#ng for correct consistency of texture modified foods and liquids before serving than health professionals
Findings