Food for All: Modifying Food Texture for People With Dysphagia

WORDS AINUL SYAFIQAH MOHD AZAHARI & DR NURUL HUDA RAZALLI

DYSPHAGIA: IT MEANS DIFFICULTIES IN SWALLOWING FOODS & LIQUIDS
  • Dysphagia comes from  Greek word ‘dys’, which means difficulties, and ‘phagia’, which means swallowing.
  • Medically, dysphagia is a term for swallowing difficulties. Someone with dysphagia takes more time and effort to move food or liquid from their mouth down to their stomach.
  • Episodes of dysphagia can be intermittent or progressive.
IT IS A SYMPTOM FOR MANY MEDICAL CONDITIONS
  • In adults, dysphagia is very common in adult that has a history of stroke, dementia, Alzheimer’s disease, neck cancers, and gastroesophageal reflux disease (GERD).
  • It could also be present in children with attention deficit hyperactivity disorder (ADHD), autism, Down syndrome, and cerebral palsy.
  • Dysphagia can also be a sign that there are some issues with the many nerves and muscles that are involved in swallowing activities.
YOU MAY HAVE DYSPHAGIA IF YOU EXPERIENCE THE FOLLOWING
  • Persistent drooling of saliva
  • Coughing or choking when eating or drinking
  • Bringing food back up, sometimes through the nose
  • Feeling as though food is stuck in your throat or chest
  • Being unable to chew food properly
PEOPLE WITH DYSPHAGIA FACE ISSUES THAT CAN JEOPARDIZE THEIR HEALTH & WELL-BEING

Choking and lung infection

Individuals with dysphagia are susceptible to choking. Due to difficulties in swallowing normally, consumed foods or liquids can accidentally enter the airway into the lungs. This could result in aspiration pneumonia, often known as a lung infection and can be fatal.

Poor nutrition intake
  • The prevalence of malnutrition among people with dysphagia is reported to be anywhere between 3% and 29%, which is quite a high number.
  • Malnutrition leaves people with dysphagia more vulnerable to diseases, should they not receive enough essential nutrients for optimal body function.
  • Muscle wasting, underweight, and stunting could be other issues that arise. Hence, people with dysphagia needs to be aware of any weight loss, hair loss, feeling of coldness, and fatigue as these are the early symptoms of malnutrition.
Loss of appetite and fear of mealtimes
  • People with dysphagia often lose their appetite in conjunction with their reduced swallowing ability.
  • They might develop some degree of “laziness” when it comes to drinking more often, which may lead to dehydration.
  • Because their eating experiences can be difficult, uncomfortable, and unpleasant, they may develop anxiety during mealtimes.
Inability to talk fluently
  • Dysphagia can hinder one’s ability to talk fluently and, combined with difficulties in eating, may cause the affected person to experience low self-esteem and lead to self-isolation.
  • The decrease in social engagement will give a negative impact in the person’s quality of life.
  • Thus, social support from their carer, family members, and close friends are crucial. A little extra kindness and help will give a huge impact in their life and sometimes even touch their heart.
Proper nutrition management for people with dysphagia involves providing adequate nutrients through modification of food texture and fluid consistency.

We need to also keep an eye out for symptoms of dehydration such as dry mouth or tongue, thirst, headache, and lethargy. 

Also, be alert to any unexplained weight loss, hair loss, feeling of coldness and fatigue—these could be early symptoms of malnutrition.

IF YOU ARE WORRIED THAT YOU OR SOMEONE CLOSE TO YOU HAVE DYSPHAGIA

Consult a speech language pathologist, a healthcare professional trained to diagnose dysphagia, for a proper diagnosis.

People with dysphagia can consult with dietitians for their nutritional concerns or if they want to assess their nutritional adequacy.

TIPS FOR INDIVIDUALS WITH DYSPHAGIA TO ACHIEVE GOOD NUTRITION

Understand the extent of one’s dysphagia

Discuss with the speech language pathologist and other relevant healthcare professionals on the degree of swallowing ability in the person with dysphagia.

Refer to the International Dysphagia Diet Standardization Initiative (IDDSI) Framework

This guideline has seven levels. Flow test, spoon tilt, and fork drips are used as measurement methods to determine each level.

Click to view a larger and clearer image.

Further information can be obtained from the IDDSI website (link opens in a new tab).

Modify foods into certain textures 

For more detailed information on how to modify the textures of various foods, you can refer to this page on the IDDSI website (link opens in a new tab).

  • While modifying the textures of foods into appropriate textures, take into consideration the nutritional content (carbohydrates, protein, fat, as well as vitamin and minerals). Daily meals should provide all the nutrients to improve the person’s nutritional status.
  • Always choose softer food options if texture modification is not possible. For example, choose papaya instead of apple, and ‘soften’ a dish with gravy.
  • Add special thickening powder to watery liquids. This thickening allows for easier swallowing.
Useful tips for eating
  • Have the person with dysphagia sit upright to prevent choking.
  • Have them tilt their heads to prevent liquids from going into their air passage.
  • Encourage the person to take smaller bites, and give enough time to chew the food thoroughly.
  • If small pieces of food or liquid are stuck, have them cough a little.

Dysphagia is a journey of eating experience that may switch an individual’s life 360 degree. Hence support and motivation play an important role in the management of one’s dysphagia.


References:

  1. O’Rourke, F., Vickers, K., Upton, C., & Chan, D. (2014). Swallowing and oropharyngeal dysphagia. Clinical medicine (London, England), 14(2), 196–199. https://doi.org/10.7861/clinmedicine.14-2-196
  2. Shaheen, N. A., Alqahtani, A. A., Assiri, H., Alkhodair, R., & Hussein, M. A. (2018). Public knowledge of dehydration and fluid intake practices: Variation by participants’ characteristics. BMC public health, 18(1), 1346. https://doi.org/10.1186/s12889-018-6252-5
  3. Ueshima, J., Momosaki, R., Shimizu, A., Motokawa, K., Sonoi, M., Shirai, Y., Uno, C., Kokura, Y., Shimizu, M., Nishiyama, A., Moriyama, D., Yamamoto, K., & Sakai, K. (2021). Nutritional assessment in adult patients with dysphagia: A scoping review. Nutrients, 13(3), 778. https://doi.org/10.3390/nu13030778
  4. World Health Organization. (n.d.). Fact sheets – malnutrition. https://www.who.int/news-room/fact-sheets/detail/malnutrition

Get the Flu Shot to Prevent a Heartbreaking Holiday Season!

In Malaysia, flu can occur year-round. Older persons, especially those with chronic diseases such as diabetes and high blood pressure, are advised to make flu vaccination an annual priority, especially during the holiday seasons when mingling and traveling are often inevitable. It’s important to strike a balance between staying safe and creating beautiful memories!

DO YOU KNOW THAT YOU COULD END UP WITH A HEART ATTACK OR STROKE WHEN YOU GET THE FLU?

Recent studies have cautioned that influenza increases the risk of heart attack by more than 10 times in the first 7 days after contracting the flu.

This is especially so if you are 65 and over, regardless of whether you have a history of heart disease or are living with chronic illnesses such as heart disease, diabetes, lung disease and kidney disease. In industrialized countries, most deaths associated with flu occur among older persons aged 65 years and above!

Among older persons, influenza can present as a relatively mild respiratory illness; it may also present without any symptoms (no fever and/or no cough). It can also lead to fatigue and confusion, potentially setting off a sequence of catastrophic events.

Professor Datuk Dr Zulkifli Ismail, Technical Committee Chairman of the Immunise4Life Programme, explains: “It is not just a fever, runny nose, cough and body aches, it could seriously harm your heart.”

HOW THE FLU AFFECTS YOUR HEART

When the flu virus enters your system, your immune system strings into action.

Just like fights in real life, collateral damage may result; when an infection triggers a strong response from your immune system, the immune cells can also damage your own healthy tissues and organs.

One example is COVID-19, which can trigger very high activation of the immune system, resulting in the uncontrolled release of cytokines, small molecules that aid cell-to-cell communication in immune responses and stimulate the movement of cells towards sites of infection.

This uncontrolled release (“cytokine storm”) may lead in failure and death of many organs in the body.

 

An illustration of cytokine storm, sometimes called hypercytokinemia, and how it affects both healthy and infected cells. Click on the image for a larger version.

Studies suggest that the same inflammatory response described above can trigger effects that can damage the heart (cardiovascular events) when you have an influenza infection.

Dr Alan Fong, the President of the National Heart Association Malaysia (NHAM) and a consultant cardiologist, shares that your body’s immune response, when present along the direct effects of flu on the inner lining of your blood vessels or atherosclerotic plaques, may cause rupture of such plaques or blockage in the arteries–effects that can lead to a heart attack or stroke.

OLDER PERSONS ARE ESPECIALLY AT RISK WHEN THEY CATCH THE FLU

In older persons, there are changes that occur in the immune system that leads to a decline in the ability of the body to fight off infections such as the flu; this is known as immunosenescence.

Professor Dr Tan Maw Pin, a consultant geriatrician that chairs the Flu & Older Persons Sub-Committee of the Malaysian Influenza Working Group (MIWG), tells us: “In addition to this, ageing contributes to chronic, non-infectious, low-grade inflammation—known as inflammaging—which plays a key role in the cause and progression of chronic conditions such as cardiovascular diseases.”

She further adds that ageing also promotes the development and progression of atherosclerosis, the most common cause of acute coronary syndrome. This syndrome gives rise to situations in which the blood supplied to the heart is suddenly blocked.”

“Hence, when an older person gets the flu, all these factors put them at higher risk of developing a heart attack and stroke,” Prof Tan reiterates.

FLU VACCINATION CAN PROTECT YOUR HEART

Studies have found that the flu vaccination was associated with a 34% lower risk of major adverse cardiovascular events, and those that have recent acute coronary syndrome had a 45% lower risk.

There is also an 18% reduced risk of death reported in patients with heart failure.

For people with type 2 diabetes mellitus, studies have shown that the flu vaccination reduces the risk of heart failure by 22%, stroke by 30%, heart attack by 19% and pneumonia by 15%.

Flu vaccination does not require behaviour change or a daily intervention, yet it prevents cardiovascular events as well as as other evidence-based approaches such as statin therapy, antihypertensive therapy, and smoking cessation.

This article is contributed by Immunise4Life (IFL), a collaboration of the Ministry of Health Malaysia with the Malaysian Paediatric Association (MPA) and the Malaysian Society of Infectious Diseases & Chemotherapy (MSIDC).

The article has been edited by HealthToday for publication on this website.

For more information on flu, you can visit IFL’s website Act of Love (link opens in a new tab).


References:

  1. Warren-Gash, C., Blackburn, R., Whitaker, H., McMenamin, J., & Hayward, A. C. (2018). Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland. The European respiratory journal, 51(3), 1701794. https://doi.org/10.1183/13993003.01794-2017
  2. Michos, E. D., & Udell, J. A. (2021). Am I getting the influenza shot too?: Influenza vaccination as post-myocardial infarction care for the prevention of cardiovascular events and death. Circulation, 144(18), 1485–1488. https://doi.org/10.1161/CIRCULATIONAHA.121.057534
  3. Modin, D., Jørgensen, M. E., Gislason, G., Jensen, J. S., Køber, L., Claggett, B., Hegde, S. M., Solomon, S. D., Torp-Pedersen, C., & Biering-Sørensen, T. (2019). Influenza vaccine in heart failure. Circulation, 139(5), 575–586. https://doi.org/10.1161/CIRCULATIONAHA.118.036788
  4. Vamos, E. P., Pape, U. J., Curcin, V., Harris, M. J., Valabhji, J., Majeed, A., & Millett, C. (2016). Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 188(14), E342–E351. https://doi.org/10.1503/cmaj.151059
  5. King, S. C., Fiebelkorn, A. P., & Sperling, L. S. (2020, November 2). Influenza vaccination: Proven and effective cardiovascular disease prevention. American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2020/11/02/14/42/influenza-vaccination-proven-and-effective-cvd-prevention
  6. Vetrano, D. L., Triolo, F., Maggi, S., Malley, R., Jackson, T. A., Poscia, A., Bernabei, R., Ferrucci, L., & Fratiglioni, L. (2021). Fostering healthy aging: The interdependency of infections, immunity and frailty. Ageing research reviews, 69, 101351. https://doi.org/10.1016/j.arr.2021.101351