Dysphagia Toolkit

Nourished Aging Toolkit:

Dysphagia Education: Fluids

Message From Sysco’s Nutrition Services Team

Older adults, living within Long Term Care or Retirement settings are at increased risk of swallowing difficulties and dysphagia.Both have an impactful influence on individual's overall health & wellbeing, along with quality of life.

This resource will focus on dysphagia education, including practical tips to address and manage swallowing difficulties and dysphagia. This resource will focus on topics such as:

• Understanding Dysphagia

• Nutrition in Dysphagia Management

• The International Dysphagia Diet Standardization Initiative (IDDSI)

Product suggestions are also included in the toolkit. Please reach out to your Sysco Sales Representative for more information.

Note: The information provided within this toolkit are suggestions and should be implemented in consultation with a Registered Dietitian & Speech Language Pathologist and in accordance with your home specific policies and your resident’s individual needs.

- Sysco Canada’s Nutrition Services Team

Swallowing Difficulties

What is Dysphagia?

• Difficulties with chewing and/or swallowing foods or fluids

• Occurs when the passage of food or fluids from the mouth to the stomach is delayed or hindered1

• Caused by mechanical obstruction (i.e. head and neck surgery) and/or poor motor function (i.e. stroke, head trauma, etc.)1

• Risk factors include aging and natural aging of the esophagus and greater risk of health conditions including Dementia, Parkinson's Disease and Strokes2

• Ongoing dysphagia can lead to choking, weight loss, malnutrition, dehydration, and aspiration pneumonia3

Signs and Symptoms of Dysphagia:

• Poor mouth seal4

• Audible throat clearing4

• Coughing or changes in voice quality4

• Inability to tolerate mixed consistencies4

• Avoiding certain beverages4

• Prolonged fluid consumption4

• Significant weight changes due to decreased food and fluid consumption4

• Recurrent aspiration pneumonia5

Dysphagia Management

Who is Involved?

The Registered Dietitian, Dietary Team, Nursing Team, and/or Speech Language Pathologist are involved with dysphagia management in Long Term Care & Retirement.

• Assessment may include:

• Overall fluid intake (i.e. hydration status)

• Assess nutritional status and nutrient requirement

• Drinking abilities (i.e. level of assistance from staff)

• Need for adaptive aids (i.e. lidded/spout/nosey cups)

• Body and head positioning

• Drinking skills

• Compensation strategies to promote a safe swallow

• Dependent on resident assessment and needs, a modified fluid consistency will be assigned to residents and will be reflective on resident diet orders.

• Support, supervision and other assistance will also be indicated on resident care plans. Examples include:

• Appropriate seating and positioning

• Required assistive devices and level of assistance by team

Screening and diagnosis of oropharyngeal dysphagia should be assessed by a medical professional such an a SLP, who can advise on which texture is best as this can vary with individual needs to help reduce and manage the consequences of dysphagia

Dysphagia Management

Managing Fluid Consistencies

• Thickened fluids allow residents to control the flow of fluids in the mouth and throat to help minimize choking8 and prevent aspiration pneumonia7

• The terminology used to describefluid consistencies may differ between healthcare facilities:

• Fluid consistencies can be described as regular, nectar thick, honey thick, and pudding thick

• Some healthcare facilities have adopted the International Dysphagia Diet Standardization Initiative (IDDSI) and describe fluids as thin, slightly thick, mildly thick, moderately thick, and extremely thick

• Commercial thickeners or pre thickened commercial products are available for dysphagia management

Speak to your Sysco Representative for a product list of available pre thickened commercial products and commercial thickeners

Thickened Fluid Terminology

The following chart outlines the various terminology used to identify and describe fluid consistency or thickness.

N/A Slightly Thick (Level 1)

Nectar Thick Fluids

Mildly Thick (Level 2)

Honey Thick Fluids

Pudding Thick Fluids Extremely Thick (Level 4)

• Unmodified

• Flows like water2

• Can drink with any type of cup or straw2

• Commonly used in pediatrics2

• Thicker than Water2

• Requires more effort to consume than regular fluids2

• Flows off a spoon2

• Requires effort to consume through a straw2

• Able to sip from cup2

• Requires effort to consume through straw2

• Able to consume from a cup2

• Consume with a spoon2

• Cannot consume through a cup or straw2

Note: While the current, common terminology can be transitioned to IDDSI fluid levels, please ensure prepared products and recipes are re-evaluated during the adoption of any IDDSI fluid levels. Please always reference IDDSI.org for up to date information.

The International Dysphagia Diet Standardization Initiative (IDDSI)

What is the International Dysphagia Diet Standardization Initiative (IDDSI)?

The International Dysphagia Diet Standardization Initiative includes “standardized terminology and descriptors for dysphagia diets that would meet the needs of individuals with dysphagia across the age span, across all care settings and across all cultures9.”

The IDDSI Framework & Testing Methods

The IDDSI Framework outlines the standardized terminology and descriptors for all diet texture and fluid consistencies. The framework consists of a continuum of 8 levels; Level 0-4 measures fluid consistency and Level 3-7 measure diet textures9.

Included in the IDDSI Framework are IDDSI Testing Methods: The Testing Methods are intended to confirm the flow or textural characteristics of a specific product at the time of testing9.

To learn more about the IDDSI Framework & Testing Methods, click here.

Resident Centered Care

A resident’s diet order must be in line with their nutritional goals and preferences. A resident may decline thickened fluids due to:

• Unfavourable texture

• Taste alterations

• Not thirst quenching

Note: Resident safety is always priority, however resident specific needs may require strategies & solutions determined by the care team to improve resident intake & satisfaction

Fraizer Water Protocol

• The Frazier water protocol is one method that may help decrease risk of dehydration for residents who dislike thickened fluids

• Enables prescreened residents to freely consume regular water prior to a meal/snacks and 30 minutes after food intake to ensure that residents will not aspirate on food particles10

• Small amounts of water (neutral pH) in the lungs can be absorbed quickly by the body and decrease risk of aspiration11

• Frequent oral care is required to ensure resident safety10

The Fraizer Water Protocol should be implemented in consultation with a Registered Dietitian & Speech Language Pathologist & in accordance with your home specific policies

Sysco Canada Nutrition Services Team

Nutrition Services Team Synergy Tech Suite Updates

• At Sysco Canada, the Nutrition Services Team updated the Synergy Tech Suite database to support IDDSI initiatives for fluids. This includes:

• Updates to database of thickened fluid recipes to meet IDDSI level standards

• Updates to preparation steps for all fluid recipes

• Tagging of fluid recipes using the Synergy Tech Suite Tagging Feature (with disclaimer attached)

• Fluid Sub-grid is updated bi-annually for each Sysco Menu launch

Nutrition Services Team Resources

• For more information on IDDSI you can view our Nourishing Conversation Series (April 8th, 2021) here where Campbells & Voortman share their texture modified recipes & IDDSI updates.

• You can also access videos from Canadian IDDSI Reference Group (CIRG) Industry Partner Forum here

Sysco Synergy Tech Suite

Use integrated foodservice software to support you & elevate your level of care!

How Synergy Tech Suite®’s all-in-one foodservice technology can help you plan and deliver personalized diets and textures:

Sysco's Nutrition Services Team of Nutrition Services Consultants, including Registered Dietitians and Nutrition Managers, understand that delivering personalized care and adhering to frameworks like IDDSI can be challenging– especially when you already have enough of your plate. That's why Synergy Tech Suite® is dedicated to providing solutions that make the complex, simpler.

Here are just a few of the ways Synergy Tech Suite® technology can help make implementing IDDSI in your community that much easier:

• Create and manage IDDSI food textures and fluid consistency diet types

• Create Texture and Fluid modified recipes efficiently

• Create and manage Diet Order Tags specific to IDDSI levels so you can easily search recipes

• Comprehensive People Profiles and Connect Technology help keep your team up-to-date on any residents’ texture and diet requirements.

If you want to standardize and simplify your menu planning process as you implement IDDSI, or learn more about the benefits of end-to-end technology to resident safety and satisfaction contact support@mealsuite.com

Thickened Juices & Beverages

At

Thickened Juices & Beverages

Sysco Imperial Thickened Juices and Beverages are specially formulated to provide hydration and vitamin C to your residents with dysphagia. The refreshing flavors and smooth consistency encourages consumption and each 4 fl oz serving provides 100% DV of vitamin C.

Outstanding Quality and Convenience

• Each 4 fl oz serving provides 100% daily value of vitamin C

• Smooth consistency in every swallow

• Shelf stable; no refrigeration required until prior to serving

• Available in both bulk 46 fl oz and single serve 4 fl oz containers

*These items are labeled according to U.S.A. labeling standards

†These items are labeled according to Canada labeling standards

SBFH203 03/2022

Thickened Coffee & Tea

At the heart of food and service

Thickened Coffee & Tea

Residents with swallowing difficulties can enjoy a hot cup of coffee or tea instantly with Sysco Imperial pre-portioned thickened beverage mix packets. Our single serve packets make it easy to serve these beverages any time of day.

Plus the thickened coffee and tea are unsweetened and decaffeinated. Appropriate for most special diets, residents can still add small amounts of milk or cream to their favorite beverage to consume the way they like. Available in both level 2 mildly thick and level 3 moderately thick.

Convenient & Versatile

• Black tea and coffee can be served as is or with the addition of sweetener, cream or non-dairy creamer to suit every resident’s needs

• Decaffeinated tea and coffee to serve up any time of day

Easy on Staff & Budget

Safe Swallowing

• Color-coded packets for level 2 and level 3 prevent mix-ups

• Small amount of cream or milk can be added without changing consistency

• Smooth, lump free consistency

• Easy preparation, just add 6 fl oz of hot water, stir and serve

• Dry mix packet allows for easy storage

• Single serve packet fits easily on patient’s tray

• Economic alternative to preparing thickened coffee and tea in the kitchen

Instant Food Thickener

Instant Food Thickener

Whether you prefer to make your thickened beverages from scratch or serve ready-to-serve thickened juices, Lyons is your solution for thickened beverages. ReadyCare Instant Food Thickener makes it easy for you to provide thickened beverages and pureed foods to your patients with dysphagia. Simply add our specially formulated thickener to hot or cold foods or liquids and, within seconds, the proper consistency for safe swallowing is achieved.

• One person can pre-thicken bulk pureed foods or beverages

• Thaw stable for advance preparation of pureed foods

• A variety of packets, cans, or case packs for individual or bulk preparation

Safe

• Provides proper food consistency to facilitate a safe swallow

• Can help maintain or improve patient hydration

• Doesn’t bind fluid and is easy to digest

For texture modified diets

Tasty hydration... all day long

WITH OUR THICKENED BEVERAGE MIXES

EASY AND INSTANT!

EZ-ThickMC Thickened beverage mix is an instant preparation specially designed for texture modified diets.

Simply add EZ-Thick required amount of water to achieve desired beverage thickness.

AVAILABLE IN 4 REFRESHING FLAVOURS

•Ready in 4 minutes! Just add water.

• The beverage thickness will remain stable for at least 4 hours.

•Made using a xanthan gum base, which has zero calories, is non sticky, safe and ideal for hydration.

•Sugar-free†.

•No preservatives.

•Kosher - Vegetarian - Gluten-free.

† Contains Sucralose

1

2 3

Hydrate your patients instantly.

DIRECTIONS:

Measure the recommended amount of

water to achieve desired thickness. Slowly add one pack of EZ-ThickTM Thickened beverage mix to water and mix quickly using a whisk until complete dispersion. Let it thicken 3 to 5 minutes. The beverage thickness will remain stable for 4 hours.

• 15 calories / 15 mL

• Neutral taste

• Kosher

• Halal

• Suitable for use with IDDSI* framework

Nutrition Facts

EZ-THICKTM can be easily incorporated into liquids and foods at different temperatures in order to obtain the recommended consistency.

How to use EZ-THICKTM in your daily routine:

1.Measure the recommended amount of EZ-THICKTM in order to achieve the desired consistency. Use level measuring spoon and / or cup for more accuracy.

2.Slowly add EZ-THICKTM to liquid and stir until completely dissolved. Liquid will thicken within 1-5 minutes. Stir or mix before serving.

Note: Product can be prepared using a blender at low speed for 60 seconds. Stir before serving. Does not alter taste.

For oral consumption only.

* Tests performed by Berthelet R&D. Small changes in thickness may occur with change in serving temperature. IDDSI Flow Test is recommended to check thickness prior to serving.

Nectar-like Honey-like Pudding 15 mL 20 mL 25 mL

Spoon-Thick

Desired Consistency per 125 mL serving**

** The required quantity of thickener is similar for all liquids but may vary for nutritional supplements.

Can be used in multiple hot and cold applications.

Not