Management
Approaches to improve swallowing technique have included holding the chin against the chest or turning the head to one side as this can change the biomechanics.1
Having the right consistency of food or drink may help swallowing, with food being mashed or liquidised and liquids thickened. For safety and to reduce the risk of aspiration, the consistency needs to be appropriate for the extent of the dysphagia.
The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a common terminology for describing food textures and drink thicknesses, for use in preparing foodstuffs by caterers, manufacturers, in care homes or by carers. This system has been adopted in the UK since 2019.31
It is important to get the balance right between thickness and palatability. Thicker preparations may reduce aspiration risk, but they can give a greater sense of satiety with a subsequent risk of dehydration as not enough fluid is consumed. Blended foods can also lose their flavour or appeal.1
Feeding tubes are another option but come with risk as they do not improve swallowing function, meaning aspiration of microbially-contaminated saliva or refluxed stomach contents may still occur. Tubing is also associated with irritation and infection, as well as being uncomfortable.