Changes in dysphagia management – affecting thickening agents and nutritional supplements used for people with dysphagia
From September 2019, the descriptions, labels and instructions for the use of modified food and drink products will change as Ireland is adopting the International Dysphagia Diet Standardisation Initiative or IDDSI. This means that Ireland will describe modified food and thickened drinks in the same way as many other countries across the world from the USA and Australia to Sweden. Consistency in how we describe the products makes it safer for the people using them.
This change was prompted by the Irish Association of Speech and Language Therapists (IASLT) and the Irish Nutrition and Dietetic Institute (INDI) who recommended that the IDDSI guidelines (2015) replace the current Irish Consistency Descriptors for Modified Fluids and Food (2009). Following a comprehensive review process and engagement with clinicians, this recommendation was agreed by the HSE Leadership Team in November 2018.
Dysphagia (difficulty with swallowing) is broadly estimated to affect 4% of the general population. This percentage is much higher among older people and people with conditions such as stroke, Parkinson’s disease, dementia, head and neck cancer. Feeding, eating, drinking and swallowing difficulties are also prevalent in certain paediatric populations. People with dysphagia can experience difficulty feeding, chewing, swallowing food, drinks or medication and be at risk of choking. Dysphagia can occur at any age and may be short or long term, with the most common causes of dysphagia being related to underlying medical or physical conditions.
There are a number of significant potential consequences related to dysphagia including life-threatening chest infection (or pneumonia), malnutrition, dehydration and reduced health-related quality of life.
One of the most common ways of managing dysphagia is the use of texture modified foods and thickened liquids. Due to the enormous variation of foods and drinks, and their properties, it is challenging to categorise them to ensure universal understanding of what types of foods and drinks best meet the needs of people with dysphagia. Confusion or miscommunication regarding diet textures and drink consistencies has resulted in increased risk of illness and even death. These are some of the reasons that the IDDSI Framework was developed and agreed by a panel of international experts and is being widely adopted globally[s1] .
At the request of Dr Colm Henry, HSE Chief Clinical Officer, the National Health and Social Care Professionals (HSCP) Office established a National Working Group which coordinated the review and approval of the IDDSI guidelines for the HSE, assessed the impact of transitioning from existing diet descriptors to new ones and developed an implementation plan.
The changeover requires careful clinical management, cooperation with product providers, supported by training for staff and information for service users, to ensure risks to people with dysphagia are minimised. The National Working Group is liaising with PCRS regarding changes to labels and mixing guidelines for nutritional products such as thickening agents and nutritional supplements for dysphagia.
A national phased changeover to IDDSI begins in September 2019 with a view to having all services transitioned in early 2020.
To assist with the implementation of IDDSI guidelines, a suite of resources have been developed by subgroups of the National Working Group to support operational services during the transition including:
- Suite of educational resources and recommended training for various staff.
- Communication resources.
- Patient information leaflet.
Community Pharmacists are asked to assist in the process by providing a copy of the patient information leaflet to patients with dysphagia on dispensing their nutritional products such as thickening agents.
Materials are available see HSE IDDSI Implementation Pack on the share centre on www.hseland.ie, relevant resources for pharmacists can also be found here. Patient information including the patient information leaflet can be found on: www.hse.ie from September. Any queries or for further go to the National HSCP office - Email: HSCP.NationalOffice@hse.ie Twitter: National HSCP Office @WeHSCPs
For more information on IDDSI see www.iddsi.org