What is Dysphagia?
Dysphagia is a medical term for swallowing problems or difficulties, and it is very common in the elderly. It can be very uncomfortable in some cases and can put people off eating all together.
Typically, a member of the Speech and Language Team will carry out an assessment and prescribe a food consistency they feel a person struggling to swallow would best tolerate. For some, this may be minced and moist, liquidised or puréed.
The guidelines for the correct consistencies have become better defined and the International Dysphagia Diet Standardisation Initiative (IDDSI) have worked very hard to standardise the textures. Up until now, the guidance has been very ambiguous – ie ‘custard thick’ for a stage 2 – leaving it up to the person preparing and serving the texture modified food to subjectify their version of custard. We have all had varying consistencies of custard over the years. What is acceptable to one person may not be acceptable to another!
This spring, the new international guidance will be changed and far easier to follow. To discover more about the guidelines and IDDSI visit their website at www.iddsi.org. Here you will find everything you need to know. There is a great resource section on the website and even an App available to make understanding the new standards and how to follow them completely foolproof!
Maintaining the delicious
The challenge we face with a texture modified diet is maintaining flavour and presentation. For those on a liquidised diet, the best solution to an appetising looking plate is to use attractive small dishes or ramekins to keep the elements of the meal separate.
For a puréed diet we can use food moulds which, as many of you will have seen within our Nellsar Homes, is a fantastic way of serving a puréed meal. The separate elements are puréed down and then moulded into the shape of the original fish fillet, sausage, chicken breast or vegetable. For those transitioning from a ‘regular’ to a ‘puréed’ diet, this makes the change feel much more dignified and visually acceptable, sending the right message to the digestive system.
The real art is in the flavour. When a food is puréed, the surface area is increased which overstretches the flavour, giving it further to go. When cooking for someone on a liquidised or puréed diet, flavour must be a priority.
The secret to great tasting puree
I have recently been on a quest to try and find the secrets of adding flavour and extra nourishment to a puréed meal. On my journey I have come across one person who, in my opinion has ‘nailed it’! Diane Wolf passionately incorporates the science of blending and preparing, with the importance of nutrition in maintaining good health and healing. Her book ‘Essential Purée’ details her story, along with a variety of recipes and ways of making delicious puréed snacks, meals and desserts.
So, let’s get down to it. The main components of making the perfect puréed meal are:
- The right equipment. Having a high-speed powerful blender to suit your needs will make sure your proteins, fruits and vegetables will be blended to a perfect consistency
- Fresh ingredients. Having a stock of these basic ingredients always on hand will mean flavour on hand. Bananas, lemons and limes, carrots, white potatoes, red potatoes and sweet potatoes, garlic, ginger, onions, scallions, mushrooms, tomatoes, avocados, celery, spinach, kale, milk, parmesan cheese, eggs and unsalted butter.
- The use of herbs. Herbs are full of flavour, antioxidants, vitamins and minerals. They are easy to use and can be homegrown.
- Sauce. The big secret is in the sauce. Protein doesn’t purée smoothly without a medium to support the smaller particles. ‘Essential Purée’ uses gravy, sauce, soup and vegetable purée as mediums for purée. They add colour, nutrients and texture.
And remember, creativity, thinking ‘outside the box’ and not being scared to experiment are also important when making a puréeed meal for someone. If you wouldn’t sit and eat it yourself, then ask yourself why? What could be done to make it better? Go to town!