OPINION: Managing Dysphagia and Nutritional Pathways

Emily Stuart, registered dietician with apetito, talks about how to cater to and manage dysphagia

Dysphagia is the clinical term for swallowing problems and can be linked to both eating and/or drinking. Issues with swallowing can be seen in various stages of the swallow including the positioning of food in the mouth, chewing, moving food around the mouth, sucking, or in the general overall process of swallowing.

Dysphagia is a complex condition that is secondary to numerous primary conditions, including but not limited to:


  • Neurological conditions such as strokes, multiple sclerosis, motor neuron disease, parkinson’s disease, dementia and head injuries
  • Head and neck cancers or when radiotherapy treatment has led to swelling or soreness in the oesophagus which has impacted the swallow
  • Intubation or insertion of a tracheostomy on the Intensive Care Unit (ICU)
  • Cardiopulmonary disorders such as Chronic Obstructive Pulmonary Disease (COPD)
  • Autoimmune disorders: HIV, lupus, and rheumatoid arthritis
  • Ageing, gastroesophageal reflux disease (GORD) and learning difficulties



Dysphagia can be seen in both adult and paediatric populations in care homes and hospital settings. It is prevalent among certain groups of people (up to 78% of stroke residents, 80% of residents with head and neck cancer and up to 57% of people living with dementia) (2,3,4).

Dysphagia can have significant clinical implications on the individual and can lead to malnutrition, dehydration, impaired quality of life, choking, aspiration, pneumonia and in severe cases, death.

When we consider the wide range of conditions affecting people of all ages that can lead to dysphagia, we can see why it is so prevalent in care homes. It is a condition that will need to be managed in collaboration between clinical and care home settings up and down the country working closely with catering teams.

Dysphagia meal provision is likely to be a core part of any care home needs. Textured-modified (TM) foods are one of the treatments available for managing and provision of the correct and most appropriate TM meals can provide a resident with a safe meal when they are clinically vulnerable and can promote resident-centred care and support their recovery by delivering vital nutrition.

IDDSI Framework & the role of TM food

Standardisation of TM food and fluids is assessed against the International Dysphagia Diet Standardisation Initiative (IDDSI) Framework, which replaced the old ‘National Descriptors’ in 2019. The purpose of the framework is to promote common (international) terminology to describe food and fluid thickness levels and to define testing methods that can be done by anyone using standard kitchen equipment such as a spoon or fork. To describe food thickness, the following definitions apply:


  • Level 3/Liquidised
  • Level 4/Puréed
  • Level 5/Minced & Moist
  • Level 6/Soft & Bite Sized
  • Level 7/Easy to Chew

When considering the provision of TM food for residents with dysphagia; safety and assurance, choice and variety, cost, and nutrition are all key elements that need to be considered. Care home caterers have an important role to play in not only providing residents with the correct meal but in endeavouring to speak positively about TM food to those people who are living with dysphagia.

apetito has an extensive range of meals suitable for use in care homes.  We provide products in levels 3, 4, 5 and 6, and we also have a range of products that are tested against the criteria for Level 7 Easy to Chew. Each of our TM product ranges have options that meet the British Dietetic Association (BDA) criteria for energy dense (ED) and are designed to be higher in calories to support the nutritional needs of residents with dysphagia who are at risk of malnutrition or are already malnourished.

All apetito’s products comply with the BDA Nutrition and Hydration Digest (7), and we have a variety of tasty options from classics such as roast dinners, to curries and desserts.  

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