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