People with chewing & swallowing problems need customized nutrition

Proper nutrition is essential for seniors, the sick and elderly when it comes to to maintaining health and quality of life. But people with chewing and swallowing problems lose their appetite and risk becoming malnourished as a result. In collectivities and care centers, this is a major problem where health care providers duly taken into account. One solution is to offer food in an adapted structure as well as starting adapted nutrition.

Regardless of age, “eating” should be a positive experience. For many, the meal is the most important time of the day, but age-related symptoms or illnesses can negatively affect the meal experience.

Eating is a mechanism we no longer think about. For example, the tongue helps move food around in the mouth. Chewing makes the pieces smaller and saliva creates a homogeneous mass that we eventually swallow. But with a bad or damaged palate, bad teeth or dry mouth syndrome, chewing becomes difficult and eating becomes agony. Regardless of age, “eating” should be a positive experience. (Photo Revogan) The swallowing process is complex and aims to move food from the mouth to the esophagus without pieces ending up in the airways. After a brain injury (for example, a CVA, an accident or a brain tumor), a disorder of the nervous system (such as Parkinson’s or ALS), with dementia, with cancer or after surgery in the head and/or neck area (narrowing of the pharynx or esophagus), disturbances in the swallowing process can occur. Inappropriate meal consistency creates a high risk of choking, pneumonia or even choking.

To determine the degree of malnutrition, there are several test methods such as the SNAQ (Short Nutritional Assessment Questionnaire). The test consists of questionnaires that measure, for example, whether the senior has lost weight in the last six months. There are also questions about whether or not appetite is decreasing and about the senior’s general physical readiness (functionality). With a measurement of the senior’s upper arm circumference, useful information can also be gathered. If the tests show that one has entered the “alarm phase” (for example, a weight loss of more than 4 kilograms in six months, an upper arm circumference less than 25 centimeters, or evidence of diminishing appetite and physical preparedness), then it is high time to take action.

The solution to combat malnutrition in seniors is first and foremost to restore people’s appetite for food. It is important to provide real food for as long as possible and to further stimulate the taste buds.

In people with severe chewing and swallowing problems, it is necessary to adjust the consistency of food. “Solid food sometimes needs to be reduced in size by grinding or mixing. Liquid food then needs to be thickened again.” In adjusting the consistency of the food, cooks can best rely on the guidelines of the IDDSI: “The International Dysphagia Diet Standardization Initiative (IDDSI) is an independent group of scientists who have proposed a uniform, internationally recognized classification for chewing and swallowing levels. A classification is made between eight different levels of consistency (0-7) ranging from a coarse texture to liquid, strained food. Depending on pathology and diagnosis, the treatment team determines the level best suited for the senior. The kitchen team and family caregivers can then adjust the nutrition to the desired level. This applies to both solid and liquid foods. Sometimes solid foods need to be reduced, pureed and moistened to the point that they become liquid. On the other hand, sometimes liquids need to be thickened to the point where they can be eaten with a spoon.”

“With proper attention from the entire care team, eating can become a positive experience again for our frail seniors.”

Offering nutrition with appropriate consistency to seniors is a good step to combat malnutrition, but it is not enough. This group of people eat small portions, often only 1/3 of a regular meal. The big challenge is to provide as many calories and twice as much protein in these small portions as in a regular serving. It is also better to spread meals throughout the day: three main meals, two intermediate meals and a late evening snack. All meals together preferably provide 1800 to 2000 kcal and about 80 g of protein (1.5 g protein/kg body weight/day).

Benedicte De Zutter gives some examples of adapted food products that can provide relief for people with chewing and swallowing problems and/or malnutrition: “Our Instant Protein cereal flakes can perfectly replace any bread meal because they are balanced and vitaminized. They are available in a dozen different flavors and the texture is adaptable to various IDDSI levels. Furthermore, there are refreshing fruit juices enriched with high-quality protein to start the day. In addition, there are small cakes with soft filling that whet the appetite and promote recovery. They are a good alternative to classic supplemental foods. Another dairy and fruit snack is a mini bavarois, ideal for people with dysphagia.”

An example of convenience products are puree cubes (100% pure vegetables, meat, fish or fruit), which are very smoothly blended and completely free of bits and pieces. They can be used as such or processed or possibly enriched with additional protein. High-protein soups, meat, fish, poultry or vegetable preparations can be made in less than five minutes. Still other tools are ready-to-eat hot meal components. Finely pureed foods without pieces with a soft and/or smooth texture can be eaten either with a fork/spoon or with the hands. Once in the mouth, they lose their texture so they can be swallowed without any problems. They are delivered frozen and can be easily reheated in a steamer, regeneration cart or microwave oven. Those who want to prepare their own soft and finger foods can blix the day’s meal and then bind it with the protein-rich and gluten-free Revogan soft and finger food mix. Drinking is also a big problem for people with swallowing problems. For these people, there is Prodia instant gelled water (strawberry or orange flavor) and Revogan thickeners, among others, to bind liquids to the desired thickness. “With the necessary attention of the whole care team together (nursing, logo, caregivers, cooks, kitchen team,…) eating can become a positive experience again for our frail seniors. Suitable food, in terms of both content and texture, contributes to a high-quality old age, which our seniors have richly deserved”, concludes Benedicte De Zutter.