Dysphagia is a swallowing disorder, estimated to affect 8% of the general UK population. Someone with dysphagia might experience trouble with; swallowing food or drinks, chewing, sucking, controlling saliva, taking medication, or protecting the airway from choking. IDDSI has been developed to address the muddled framework that there is today.
We are lucky enough to partner with Sunrise Senior Living, so we took the opportunity to pick the brain of Sophie Murray, Head of Nutrition and Hydration at Sunrise. Sophie is a part of the UK working party for IDDSI, helping to spread the message about this new framework.
“Sophie, thank you for taking the time to speak with me about IDDSI. First of all, what is IDDSI? Why has it been developed?”
“IDDSI is a framework for the health and social care industry, in relation to providing food and drink of the correct size and thickness for those with dysphagia. The old framework didn’t have the scientific knowledge behind the testing methods and were open to interpretation, which was putting people at risk. Therefore, IDDSI has been developed to provide scientific testing methods.”
“What does the framework for IDDSI consist of?”
“The framework for IDDSI is set out as a pyramid, with reference to different levels for both food and drink. Levels 0-4 relate to the thickness of drinks and levels 3-7 relate to food texture. There is an overlap between these levels due to some foods and drink having similarities, however the testing methods are different.”
“These testing methods you’re referring to, what are they based on?”
“There is more solid research around the size of particles that can cause choking, in relation to the size of the trachea. Particle size is based on understanding what size particle could cause choking, however it is now far more specific! Moreover, on the basis of particle size and choking, level 6 relates to a person’s ability to breakdown foods with the tongue. So, level 6 of the framework states particles should be no larger than 15mm. Every level encompasses choking risk and the ability a person with dysphagia has, to break down foods."
“Will IDDSI be rolled out internationally?”
“It has already – the UK is not the first country to implement IDDSI, New Zealand has already adopted the new framework in their health and social care sector, with Canada not far behind. Peter Lam – Co-Chair for the International Dysphagia Diet Standardisation Initiative – is leading the roll out of the framework in Canada as we speak! The importance of this being an international standard is never before have we spoken the same language as other countries, therefore healthcare workers, social workers or even residents travelling from other countries will have an understanding of the IDDSI framework, therefore reducing risk and improving care."
“What are your thoughts on the health and social care industry adjusting to the addition of IDDSI?”
“I feel the industry will only be able to adjust with the correct training. This will need to be a whole team approach. Training will need to be understood and led by the team leader, and then rolled out. Obviously IDDSI is encompassed within dysphagia, however additional awareness needs to be raised. Dysphagia training cannot be completed without addressing IDDSI. Ultimately the industry needs to know how to identify dysphagia and what to do about it, and this is where IDDSI addresses the ‘what to do about it’.”
“Do you think there will be any challenges?”
“Potentially, yes. If the wrong information is used, it could create a fear culture. Therefore it needs to be implemented methodically; by April 2019, all areas within the health and social care industry will need to assess their current processes and identify what conversations need to be had and what changes need to be made. Suppliers will need to be aware of the changes, so it can be established whether or not they will be able to support you. Another factor is having an understanding of who the speech and language therapist is in the surrounding area, and what their assessment might look like. It’s a massive coordination that needs to happen between the primary organisation, suppliers and other health professionals. Once the industry has an understanding, it’s not scary, and by making this definitive switch there is encouragement that we are safer than we ever were before.”
“Do you think IDDSI will help caregivers gain a better understanding of dysphagia?”
“Yes, I do, and this is because if you have an understanding of particle size you are naturally going to increase your understanding around swallow and choking. However, this is entirely dependent on having the correct training. Until we have our sector skills councils, Skills for Health and Skills for Care including IDDSI in their standards of training, there is still potential for disparity.”
Thank you to Sophie for taking the time to chat with me in detail about IDDSI. Look out for further information about the framework here!
The International Dysphagia Diet Standardisation Initiative 2016 @http://iddsi.org/framework/.
Supplementary Notice: Modification of the diagrams or descriptors within the IDDSI Framework is DISCOURAGED and NOT RECOMMENDED. Alterations to elements of the IDDSI framework may lead to confusion and errors in diet texture or drink selection for patients with dysphagia. Such errors have previously been associated with adverse events including choking and death.