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Dysphagia

  • How To Prepare Great Looking Rice And Pasta Dishes For Dysphagia Diets

    We are very excited to be able to offer you 2 new additions to our already extensive range of silicone food moulds which are designed to help you to significantly improve the presentation of pureed meals for the people you support with dysphagia.

    You can now add rice to your curry and pasta to your bolognese to increase the range of dishes and meals you are able to prepare, but given the consistency of these food types, what are the top tips and secrets to making visually appealing rice and pasta dishes?

    This is a question we have been asked recently, and we always like to provide helpful and informative answers to customers questions.

    Rice and pasta moulds - The key to being able to get good results with these two shapes is selecting the right thickener and the type of product used.

    For example, with rice, there is a bit of food chemistry involved and knowing the ratio of two main starches, i.e. amylose and amylopectin.

    Here is a little food chemistry to put you to sleep……

    Amylose is a long, straight starch molecule that does not gelatinize during cooking. Grains with high amounts of amylose will be fully and separated once cooked. Long grain rice typically has high amounts of amylose (about 22%) and the least amount of amylopectin (ex. long-grain varieties, Basmati and Jasmine).

    Amylopectin is a highly branched starch molecule that is responsible for making rice gelatinous and sticky. Rice with a high amount of amylopectin will be very sticky once cooked. Short grain rice typically contains the lowest levels of amylose and the highest of amylopectin (ex., short-grain, Asian-style types of rice).

    So, with all that said, it is best to use long-grain rice such as basmati or jasmine.

    Click here to view our full range of silicone food moulds including the rice and pasta moulds

    The Next Thing To Consider Is Which Thickener Should I Use?

    Our manufacturers believe that using an Agar Agar based thickener or potentially gelatine is the way to go to get the best results.

    In case you are unaware of Agar Agar thickener, it usually requires you to heat to a certain temperature to activate its gelling properties.

    So, here is a basic method for you, of what the manufacturers have done to get the best results:

    1. Add equal portions of cooked rice (long grain) or pasta and liquid (stock) to the blender N.B. Be sure to rinse and drain uncooked rice well to remove excess starch before cooking.
    2. Blend until pureed
    3. Add Agar Agar thickener and blend again
    4. Transfer contents to saucepan
    5. Heat mixture to ~ 90C to 'activate' the thickener
    6. Transfer mixture to mould cavities and cover
    7. All to cool in the fridge or otherwise freeze
    8. Heat moulded meal as per normal routine

    NB. If you are supporting people with dysphagia, please always refer to a Speech and Language Therapist for professional advice on suitable meal choices and suitable consistencies to avoid the risk of choking.

    Watch the video on how to prepare pureed rice here.

     

     

     

     

    If you would like more ideas of how to achieve greater meal variety for the people you support with dysphagia, you might like this article we previously wrote.

     

    Helping you create more varied meals for people you support living with dysphagia

     

     

    You can also download your free copy of our dignified dining guide here for more hints and tips on improving meal presentation and managing dysphagia.

  • Why Oral Care Needs To Be Given Greater Priority In Care Homes

    We carried out a recent poll to help us understand the challenges care managers are facing to achieving good oral care in care homes, and the results are in!

    • 43% of people who responded stated that ‘staff don’t see it as a priority
    • 30% put it down to a lack of guidance and training
    • 17% said staff fear personal harm
    • 9% stated there was a lack of fit-for-purpose tools

    CQC now heavily promote the importance of oral care in care homes, which includes mandatory training and forming part of the effective and responsive KLOE’s

    Here, Kate Terroni, Chief Inspector for Adult Social Care at the Care Quality Commission (CQC) talks about the importance of oral health:

    “Oral health has a huge impact on our quality of life and we need professionals across a number of sectors to make changes to ensure it is given the priority it needs in care home settings.

    “Oral health cannot be treated as an afterthought. It can make the difference between someone who is free from pain, enjoys eating and is able to confidently express themselves through talking and smiling – and someone who is in pain, unable to enjoy their food and who covers their mouth with their hand when they smile because they are ashamed of their poor oral hygiene but unable to address it themselves. No one should have to live like that.”

    And yet there still seems to be a huge gap between where we are and where we need to be on understanding the huge impact oral health has on overall health.

    Did you know that the state of your teeth affects your overall health, with gum disease linked to lots of serious health problems in other parts of the body?

    Therefore, brushing your teeth regularly to remove plaque can prevent gum disease and improve your overall health.

    Chief Executive of the British Dental Health Foundation, Dr Nigel Carter, explains: "The link between oral health and overall body health is well documented and backed by robust scientific evidence. Despite this, only 1 in 6 people realises that people with gum disease may have an increased risk of stroke or diabetes. And only 1 in 3 is aware of the heart disease link."

    Gum disease may increase your risk of all kinds of other health complications, including stroke, diabetes and heart disease. Gum disease has even been linked with problems in pregnancy and dementia.

    So why is good oral care so important?

    In a two-part BBC series, Dr Christoffer Van Tulleken, carried out an experiment where he didn’t brush his teeth for 2 weeks, to demonstrate the implications of poor dental hygiene.

    Dr Tulleken commented: ‘At the end of this time, I brushed my teeth and my gums bled; I had developed mild gum disease - an infection of the tissues that support the teeth. It's mainly caused by bacteria from plaque build-up on all hard surfaces of the mouth due to lack of oral hygiene. Carry on like this and not treat the problem and I could lose some teeth.’

    Further tests showed that he had also damaged his immune system - In some people who are susceptible to gum disease, the body over-reacts to the bacteria around the gums and causes too much inflammation. In others, the inflammation doesn't clear up. The result of the intense gum inflammation is that it also affects the bloodstream, and is believed to slowly damage blood vessels in the heart and brain over a long period of time. And there is mounting evidence that shows an association between poor oral hygiene and a wide variety of illnesses including:

    • Dementia
    • Pneumonia,
    • Diabetes, and its control
    • Kidney disease
    • Heart disease and heart attacks
    • Stroke
    • Rheumatoid arthritis

    ‘Gum disease isn't just bad for your teeth; it shortens your life - simple as that. So, looking after your teeth is one of the most important health interventions you can make’ he concluded.

    How do you think you would feel if you were unable to brush your teeth for 2 weeks?

    What do you think the implications to your health and wellbeing would be?

    • Inadequate oral care can be detrimental to social and emotional well-being – people become very conscious of not having a fresh mouth and can withdraw socially.
    • Any untreated oral pain can make chewing difficult and uncomfortable and therefore impact adequate levels of nutrition and hydration for weight maintenance

    However, a good oral care regime can help to:-

    • Keep residents as comfortable as possible in palliative and end-of-life care
    • Prevent dental decay and gum disease

    We need to work together to help build knowledge and understanding of the implications of poor oral hygiene and why it needs to be made a priority.

    Why not download a copy of our free Oral Care Guide? And you can check out our comprehensive range of fit-for-purpose oral care product solutions here too.Oral Hygiene Management Guide Long CTA

    We have additional great articles relating to oral care that you may find a worthwhile read! Find them here.

     

    How can I improve oral care for my residents living with dementia?

    What are the safe alternatives to banned pink mouth foam swabs?

    CQC calls for improvements in oral health in care homes

  • Helping You Create More Varied Meals For The People You Support With Dysphagia

    I remember well, having a conversation with Sinead, a care catering chef customer of mine, that whilst in hospital being treated for throat cancer, her Dad was served only 3 things at mealtimes, rice pudding, custard and jelly for the entire time he was there.

    It was a clear demonstration that hospital catering staff were ill-equipped to cater for people with Dysphagia, and Sinead was both appalled and heartbroken at the lack of dignity, care and attention shown to her Dad concerning his nutrition because he had swallowing difficulties.

    Sinead went back to her care home, a lady on a mission, passionate to improve a) the presentation and b) the variety of pureed meals they served for their ladies and gents, and went on to write a book and to work with us helping to educate other care catering teams.

    We regularly get asked by care home managers how to achieve greater meal variety for dysphagia diets so we know this is a genuine challenge you face, and we always love helping you to solve your challenges!

    You may like one of our previous articles with recipe ideas we recently wrote:-Puree Food Molds – 5 Nutritious Puree Food Recipes

    As people with dysphagia have a higher risk of malnutrition, it is absolutely vital that they get a good variety of tasty, nutritious and visually appealing meals and, more importantly, also that they do not feel marginalised or treated differently at mealtimes.

    With a few notable exceptions, with the right tools at your fingertips most foods are easily pureed.

    So, it is more the case that we need to work on our pureed food mindsets, get creative and remember that:

     

    1. Pureed food is still food. It doesn’t have to be bland and tasteless. Some of the world’s great chefs use pureeing.
    2. People living with dysphagia have the same needs for balanced meals as everyone else does. And their taste buds are still active too!

    What is preventing you from serving the same meals to all of the people you support, regardless of their needs and creating a fantastic inclusive mealtime experience for all?

    Having the right tools to create dysphagia diets is key as the finished dishes must meet the international IDDSI standards that follow clinical recommendations to reduce risk.

    So having a good quality food processor or blender is essential to finely process foods to a completely smooth consistency.

    Food thickeners are used to thicken liquids and foods to various consistencies. They help to slow the transit of foods and fluids to allow more time to coordinate the swallowing process safely.to create the exact required safe consistency. This prevents foods and fluids from entering the lungs and causing serious complications.

     

    NB: Always refer to your Speech and Language Therapist for correct clinical advice for the people you support with dysphagia

    It’s also really important to remember that people often refuse to eat what they can’t recognise, and one of the key challenges with pureed food is how to recreate the original shapes of meals.

    Here, food moulds can be incorporated to create the original shapes of pureed food, ie a piece of chicken, a portion of peas, sausages and more. They are available in 12 varieties by food type, as listed below, however they are extremely versatile to help create many different meals as we explain.

    NB: Food thickener is added to the food prior to placing in the mould to help retain the food shape and create the appealing finish

    Handy tip

    When I talk to care home chefs who have mastered the use of food moulds they also tell me that they have helped to significantly reduce their food waste, as any leftover foods they have, they now just puree down, fill their moulds and freeze portions for another day. Quick, simple, done!

    Here are a few meal suggestions:

    Breakfast:

    • If the people you support love eggs, prepare pureed eggs either scrambled or poached on toast
    • Try a cooked breakfast with sausage, scrambled eggs and baked beans
    • Prepared with care, cooked pureed porridge is a hearty and satisfying option with options to add apple and cinnamon for a tasty twist.
    • Mashed bananas can be created using the sausage mould
    • If you’re feeling adventurous, what about a hot bacon sandwich or baked beans on toast?

     

    Lunch: Midday presents another opportunity for tasty, nutritious meals, here are just some examples of what you can produce:

    • Build a puree roast dinner featuring favourite sliced meat( in sliced meat mould), mashed potatoes( in rice mould) and one or two veggie portions (carrot, broccoli, green beans or cauilflower)
    • Steak and chips can be easily presented, (providing the meat is tenderised) using the chicken breast and green beans moulds, or substitute steak for fish (fish fillet mould) if you prefer
    • Many casserole dishes and stews can be processed and presented. Try a pork and apple casserole with mash and veg using the cubed meat mould, rice (for mash) and any veg.
    • Create vegetarian options including a Mediterranean vegetable pasta dish (using pasta mould) with vegetable portions, or a mac and cheese with the pasta mould

    Lighter meals and snacks:

    Again, think about what you’d like on a plate. Very often, a pureed version can be just moments away. Just because someone is on a pureed diet doesn’t mean they can’t also enjoy sandwiches, biscuits and cakes. Using a soaking solution process, your people can get to enjoy their favourite snacks and treats too!

     

     

    If you would like more helpful hints and tips on managing dysphagia, then please download our free Dignified Dining Guide here

    Testimonial

    "My daughter is 12yo. She has diagnoses of Down's syndrome, oral dysphagia, autism, sensory processing disorder and food intolerances. I have only been able to give her pureed or mashed food which she was not particularly interested in. She is assisted while eating. The first time she saw her 'food moulded' dinner she shouted, "carrots!". The second time she wanted to know what every bit of food was on her plate. This time I had used parsnips in the carrot mould. "What's that, what's that?", she said as she used a fork to scoop up individual pieces of dinner into her mouth with glee. I have neither the time, energy nor interest for 'faffing' about these days so the moulds are extremely practical. Easy to clean, easy to fill with food, easy to freeze and the frozen food just pops out. I have made batches of vegetables, meat and fruit, popped them out of the moulds and stored them in another container in the freezer to use later. One can use the broccoli mould for cauliflower and sprouts. The pumpkin mould for turnip and sweet potato and as I mentioned earlier parsnip in the carrot mould. But what is most important is that my daughter is beginning to enjoy her meal times and showing greater independence .... because of the moulded food. From my experience, the silicon food moulds have been a success.

    Mrs D. Drewery

  • Our Top Tips To Help You To Fortify Texture Modified Meals For People You Support With Dysphagia To Prevent Malnutrition

    In our latest educational article we address the challenge of the links between people living with Dysphagia and the heightened risk of malnutrition and specifically answer the question recently posed to us how can we fortify meals to ensure that the people we support’s daily food intake meets daily dietary requirements.

    Jo Bonser MD told us:

    ‘We absolutely understand that supporting ladies and gents with Dysphagia and ensuring that they maximise on the correct levels of nutrition and hydration represents a huge challenge to care managers and their teams. These people are at high risk of being deficient due to consistently having to eat texture modified meals, which can offer less nutritional value, and finding it difficult to tolerate large volumes of fluids.

     

    I know from my own experience caring for my own Mum, of the challenges of supporting someone with malnutrition and learned a lot about how to fortify her meals without increasing her portion sizes, just to improve her daily calorie intake.

    The question of how can we fortify modified texture meals came up in a seminar I attended recently so it has prompted me to write a helpful, educational article which hopefully will help others too.’

     

    Dysphagia, (or swallowing difficulties) can affect a person’s ability to eat and drink leading to an inability to meet food and fluid needs and take medication, affecting their health and quality of life. This can result in a person becoming at risk of malnutrition, weight loss and dehydration.

    The key to maintaining nutrition and hydration in people with dysphagia is to promote safe swallowing and to ensure that the person has food and fluids which are of the appropriate texture and thickness.

    A texture-modified diet should ideally meet the recommended daily allowance of energy, protein and micronutrients for a meal. However, due to poor nutrient density, high dilution factor and limited palatability, modified consistency meals are known to result in significant weight loss. In view of difficulties in achieving an adequate nutritional intake from a modified consistency diet alone, food fortification may be necessary.

    This is a way of increasing the nutrient and energy content of food and drink without increasing portion sizes, making it easier to eat more calories and protein every day.

    Our top pureed food fortification tips:

    Choose liquids to added to pureed/semi-solid foods with nutritional value rather than water such as

    • Whole (full fat) milk, fortified milk and cream
    • Broth
    • Fruit juice (avoid those labelled diet, sugar-free and no added sugar)
    • Cheese sauce, white sauce, parsley sauce, bread sauce
    • Gravy
    • Custard

    High calorie snacking between meals with foods such as sandwiches, biscuits and cakes, which can be texture modified using a soaking solution, can also help.

     

    We all eat with our eyes first so it is paramount to ensure, that in addition to providing the RDA, pureed food always looks appetising and is attractively presented. It is common for people with a Dementia to refuse to eat what they cannot recognise, and as Dysphagia is common as dementia progresses, improving meal presentation with colour and contrast on the plate for everyone, regardless of their condition, ensures that nobody feels isolated or treated differently.

    The use of food moulds is becoming increasingly popular to recreate the original shapes of pureed foods as family members and care caterers understand the key benefits:

    • Improved meal presentation and nutrition
    • Increased dignity at mealtimes
    • Greater meal variety
    • Reduced preparation time ad wastage

    food molds and molded food

    Why not download our free Dignified Dining Solutions Guide here to learn more ways to help manage Dysphagia and improve the mealtime experience for the people you support.

    What challenges are you currently facing with helping the people you support living with dementia to eat better?’

    Lets get started

     

    We are offering 10 free half-hour‘ discovery’ calls with our MD Jo Bonser who supported her own Mum and transformed her mealtime experience and nutrition levels and understands the challenges you are facing.

    Get in touch

    Testimonial

    "My daughter is 12yo. She has diagnosis' of Down's syndrome, oral dysphagia, autism, sensory processing disorder and food intolerances. I have only been able to give her pureed or mashed food which she was not particularly interested in. She is assisted while eating. The first time she saw her 'food moulded' dinner she shouted, "carrots!". The second time she wanted to know what every bit of food was on her plate. This time I had used parsnips in the carrot mould. "What's that, what's that?", she said as she used a fork to scoop up individual pieces of dinner into her mouth with glee. I have neither the time, energy nor interest for 'faffing' about these days so the moulds are extremely practical. Easy to clean, easy to fill with food, easy to freeze and the frozen food just pops out. I have made batches of vegetables, meat and fruit, popped them out of the moulds and stored them in another container in the freezer to use later. One can use the broccoli mould for cauliflower and sprouts. The pumpkin mould for turnip and sweet potato and as I mentioned earlier parsnip in the carrot mould. But what is most important is that my daughter is beginning to enjoy her meal times and showing greater independence .... because of the moulded food. From my experience, the silicone food moulds have been a success".

    Mrs D Drewery

     

     

  • Dysphagia – Your Innovative Health Guide For Improved Patient Care

    senior dysphagia

    Effective nutritional management is crucial to the health of people with swallowing difficulties.

    Continue reading

  • Puree Food Molds – 5 Nutritious Puree Food Recipes

    Each year, individuals of all ages all around the world are diagnosed with feeding or swallowing difficulties (dysphagia). Put simply, dysphagia can be described as difficulty moving food, liquid, saliva or medication from the mouth to the stomach.

    Continue reading

  • How Having A Dysphagia Management Plan Can Help Transform Meal Times

     

    The normal swallow is a complex process that involves precisely coordinated movements within the mouth (oral cavity), throat (pharynx), voice box (larynx), and food pipe (oesophagus). Dysphagia is the medical term for swallowing difficulties. Some people with dysphagia have problems swallowing certain foods or liquids, while others can’t swallow at all (NHS UK). People who have had a stroke, dementia, or have a progressive neurological condition e.g. Parkinson’s disease, MS, MND, or a respiratory condition could be at risk of developing dysphagia.

    This condition can cause:

    • distress/anxiety for resident/carers
    • loss of independence
    • loss of dignity
    • a person may avoid eating drinking in the presence of others
    • social exclusion
    • eating and drinking becomes a negative experience
    • reduced motivation to eat

    Care providers must take action to ensure that:-

    • Care plans refer to IDDSI descriptors International Dysphagia Diet Standardisation Initiative
    • All staff understand the IDDSI descriptors and how to ensure that food and drink is provided in a safe manner
    • Advice is sought from specialists (SLT) whenever there is a risk of dysphagia
    • Care plans and risk assessments are consistent
    • All staff have an understanding of the normal swallow and dysphagia and know where to get more information/knowledge
    • Staff are aware of the signs of swallowing problems especially for people in the risk categories listed above
    • Staff work quickly ensure that people with dysphagia can continue to eat a healthy, balanced diet

    The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global standard. with terminology and definitions to describe texture modified foods and thickened fluids. used for individuals with dysphagia of all ages, in all care settings, and for all cultures.

    With correct plans in place, dining can be transformed and the mealtime experience for residents can be amazing. This has an improved experience for carers, friends, and families as well. Staff should be aware of the contents of the individual’s nutrition/hydration care plan and any Speech and Language Therapy (SLT) recommendations and if any changes are made then make sure staff know about the changes and record appropriately.

    All staff should document accurately in food/fluid charts (if applicable) and should know how to raise concerns about the individual’s eating and drinking.

    Think about the environment around the dining experience and check the following:

    • Reduce distractions and background noise
    • Ensure that the lighting is correct, so food is visible and looks appealing
    • Encourage socialisation, unless the individual dislikes it or it puts them at risk
    • Ensure that the dining rooms are well presented with appropriate furniture and table settings
    • Ensure that the individual can sit at their preferred location/table
    • Utensils Should be adult appropriate
    • Consider size and shape
    • Consider specialist equipment if required
    • Avoid ‘bibs’
    • Avoid beakers - especially spouted ones!

    As part of the plan, 'timing' is a factor which will allow for a more independent approach for residents especially being flexibility of timing. You can also create the following as part of the plan:-

    How a person is positioned also has to be taken into consideration when thinking of mealtimes:

    Optimum positioning is:

    • Supportive chair at a table
    • Upright at 90 degrees
    • Midline o both feet flat on floor
    • Chin tilted slightly down

    Also:

    • Use supports, cushions and rolled towels to help achieve this and assistance at mealtimes if required
    • Wash hands (staff and the individual)
    • Protect clothing (staff and residents if appropriate).
    • Sit upright at same level as the resident
    • Ensure the resident has correct dentures, glasses, hearing aids
    • Ensure correct utensils and food/fluid consistencies
    • Ensure correct food temperature

    Maintain conversation (about the food/other topics).

    • Explain about the food/ask preferences
    • Observe for difficulties
    • Allow as much independence as possible
    • Ensure face, hands and clothing are clean
    • Ensure the individual remains upright for at least 30 minutes

    The choice of food should be wide and varied with a nice presentation and an appropriate portion size. Check the consistency is correct and that the taste is great.

    Allow as much time as needed and ensure mouth is clear of food. Complete mouth care as needed with dignity. Poor oral hygiene increases the risk of aspiration pneumonia from bacteria in food residue, dentures, cavities and saliva.

    What do you need to do?

    Use a small-headed toothbrush. If possible use a sodium lauryl sulphate (SLS) free toothpaste. Brush the tongue to remove bacteria and freshen breath. Some people with restricted movements or confusion/memory problems may need help to brush their teeth.

    No need to rinse – leave the toothpaste to penetrate the teeth. Rinse the toothbrush in water and always leave it to air dry. It is also important to clean dentures – do NOT use Steradent, only use toothpaste, and brush and rinse after with water.

    If you have any questions relating to IDDSI or are coming across challenges implementing the system and would like further guidance or training then please don’t hesitate to get in touch with us as at [email protected] or telephone us on 01773 713713 we have a great network of experts who can help you.

    The CQC refer to this issue in their “Learning from safety incidents”- issue 6, this details a case study where a care plan was not updated to reflect the advice of dysphagia specialists leading to choking incidents.

    Also you can request your FREE copy of our Dignified Dining Solutions Guide – to help people with Dementia to eat better, which includes best practice advice and tips to help support your ladies and gents with Dysphagia to enjoy more independent and dignified mealtimes or visit our website to view our range of fit for purpose product solutions to help enable people living with Dysphagia.

     

  • Discover how our new and innovative anti-choking device saved a resident’s life at Ashberry Healthcare

    We believe every care home in the UK should invest in our new and innovative anti-choking device LifeVac and there are some compelling reasons why, but first we wanted to share with you a real life story from Jackie Ricketts, who works at Ashberry Healthcare, about how LifeVac saved one of her residents’ lives:
    ‘The Ashberry Healthcare Limited Nursing Home I work in saw LifeVac advertised and it was purchased as we were interested to see what it was about as we lost a resident to choking before. It arrived in the building on a Friday afternoon.

    Continue reading

  • How to reduce the risks of choking for the people you support with Dysphagia, and details of a NEW innovative new anti choking product which 1880 UK care homes have already invested in.

     

    June is Dysphagia Awareness month and so all month we have been focusing on different ways we can help you if you are supporting people with Dysphagia.

    Today we are talking about choking, how to reduce the risks of choking, some general advice to support people to eat safely -

    And an innovative new anti choking device.

    Continue reading

  • How challenging is implementing the new IDDSI framework in your care home? (We’re sharing our industry expert’s advice to help you get it right.)

    As June is National Dysphagia Awareness month, all month we are focussing on the different ways we can help and support you to achieve improved nutrition and hydration and a more dignified dining experience for the ladies and gents you support with Dysphagia.
    This week we’re talking about all things IDDSI – the new International Dysphagia Diet Standardisation Initiative.
    What is IDDSI?

    Continue reading

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