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  • Dietary management of dysphagia in aged care

    Author: Sharon Smith

Dysphagia is a condition affecting more than one million Australians, from premature babies to those in old age. According to Speech Pathology Australia, swallowing difficulties (or dysphagia) is “any problem with sucking, swallowing, drinking, chewing, eating, controlling saliva, taking medication, or protecting the lungs from food and drink ‘going the wrong way’.”

Adults can develop swallowing problems from head injuries, Parkinson’s disease, dementia, motor neuron disease and cancer of the head and neck. Such problems can lead to food, drinks or saliva entering the lungs and causing pneumonia which is risky for those with lowered immune systems.

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People with dysphagia have difficulty consuming food and drinks in their normal form, and can experience malnutrition, dehydration, immune-compromise and bouts of aspiration.

A 2015 study published in the Australian Journal of Dementia Care identified death by choking as the second highest cause of preventable death in residential aged care facilities in Victoria (AJDC, Aug/Sep 2017, Vol 6 No 4).

To ensure people with dysphagia receive food that is easy to consume and provides adequate nutrition, allied health professionals work with them and their care providers to improve their understanding of dysphagia and facilitate ways to support safer swallowing.

Speech pathologist Bernadette Dutton says meeting the nutritional needs of patients with dysphagia can be difficult, and a specific modification of the fluid viscosity (thickened fluids) and texture of the food needs to be prescribed by the speech pathologist in order to allow a safer swallow and reduced risk of aspiration pneumonia or choking.

For people experiencing timing difficulties with their swallowing, the normal process by which the epiglottal 'trapdoor' covers the airway to prevent any food or fluid entering the airway, they may benefit from thickened fluids. Thickened fluids slow down the speed fluid passes, allowing time for the "trapdoor" epiglottis to cover the airway and prevent liquid from entering the lungs.

There are four different texture modifications.
Normal – hard and crunchy (eg apple, toast, peanuts, pastry from sausage roll)
Soft – easily chewed (ie. well steamed carrots, tinned peaches, poached fish)
Minced and Moist – mashed vegetables and able to pass through the prongs of a fork.
Puree – smooth, no lumps

“Swallowing is a reflex used in everyday life, and often taken for granted. We swallow up to 900 times a day, using 26 different muscles,” says Dutton.

The same article from the Australian Journal of Dementia Care reports that somewhere between 50-68% of those in Canadian residential aged care have some kind of swallowing difficulty, and Dutton believes that some of those cases could be undiagnosed.

A uniform standard for pre-thickened fluids catering to the healthcare market did not exist in Australia when Bernadette Eriksen first learned about dysphagia. She was at home with her babies, wanting to work - and to work helping people. With backgrounds in healthcare requirements for disorders, food standards, and marketing/distribution, Eriksen decided to start making her own products.

Eriksen found the starch-thickened guar gum products on the market were having adverse effects on patients such as diarrhoea and constipation. She used her new recipe of xanthan gum and started visiting individual facilities for feedback, eventually arriving at a product that practitioners across community practice and hospitals were happy with – involving nurses, speech pathologists and dietitians.

Now celebrating 21 years, her company Flavour Creations supplies dysphagia and nutrition products that taste good and cater to nutrition, viscosity and texture, and accessibility needs for patients. Flavour Creations produces more than 100,000 cups of pre-thickened liquid each day, supplying aged care facilities, hospitals and private practices world-wide.

“I work with an engaged team that makes my job easy, and it’s very rewarding. Everything we do helps people –  it’s the best job in the world,” says Eriksen.

The product range includes thickening powders, hot and cold pre-thickened beverages, ice creams and a nutritionally complete powdered supplement. Flavour Creations’ innovation the Dysphagia Cup provides users with extra grip design and a cup rim that allows for easier sipping. A soon-to-be-released double-handled Dysphagia Cup holder will be entering the market within the next few weeks, allowing for those with arthritis, hand or finger injuries to simply hook the cup over their hand or wrist.

Erkisen’s favourite product is the ice-cream.

“Regular ice cream is whipped with air and melts really quickly – not ours. It’s creamy and made the old-fashioned way. It’s just gorgeous.”

Along with manufacturing products, Flavour Creations works with healthcare facilities in the presentation of texture-modified foods. Working with chefs, dietitians and speech pathologists, the aim of food services team is to make the food beautiful, as well as tasty and nutritious.

Flavour Creations has food moulds and a cook book for non-moulded presentation ideas for texture-modified foods, available for those wanting to help stimulate children and those with dementia who can get bored during meals, or forget they have eaten at all.

South-East Queensland aged care food service and clinical managers are invited to attend the Dysphagia Roadshow, a one-day workshop teaching texture modified moulding techniques, along with compliance testing and choking safety risk reduction procedures.


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Sharon Smith

Sharon Smith writes freelance articles as a medical, science and technology specialist. She is researching health journalism at Griffith University and lives mostly on Twitter @smsmithwriter (and would love to hear from you).