Our commitment to safe food preparation for people with dysphagia


In this article:

  • Dysphagia is a swallowing disorder that can range from mild to severe.

  • When planning meals for people with dysphagia, food texture and drink thickness are important.

  • Providence speech pathologist Kate Morell shares details about a new initiative that supports people with dysphagia -- of all age groups and in all care settings.

Most of us don’t give swallowing much thought. We just naturally do it. But for people with a swallowing disorder called dysphagia, it’s different. They can’t move food or liquid from the mouth to the stomach easily. This increases their risk of choking and of developing a lung infection called aspiration pneumonia. Dysphagia can range from mild to severe, and some people develop malnutrition because swallowing is so difficult for them.

About 15 million people in the United States have dysphagia, and the condition is more common in older adults. The primary causes are stroke and other neurological disorders, such as Parkinson’s and multiple sclerosis. People with dementia are also at higher risk. 

To treat people with dysphagia, doctors and speech language pathologists evaluate their swallowing ability and may recommend thickening the liquids and foods they consume to make swallowing safer. Recently, Providence adopted a new, international standard to test and describe food texture and drink thickness. This will improve patient safety at all Providence locations in the seven-state region. 

Adopting this standard was a significant, three-year undertaking. Providers at all inpatient facilities within Providence are using this system. They are also teaching patients and caregivers how to test food and drinks at home. 

We sat down with Kate Morell, speech pathology supervisor at Providence Portland Medical Center who has helped lead the effort, to learn more details.

Before adopting this new standard, how did providers describe and test food texture and drink thickness?

The old system was not standardized—providers everywhere (not just at Providence) had to estimate food textures and drink thickness and used different adjectives to describe them. A provider might say something was “mechanically soft,” but that wouldn’t always mean the same thing to the person preparing the food. Potentially, a patient could consume something at the wrong thickness level and choke. 

What does the new system do?

The new system is called the International Dysphagia Diet Standardisation Initiative, or IDDSI. It provides common terminology to describe food textures and drink thickness so that providers can have a better guide when preparing foods. Drinks are measured from level 0 (thin) to 4 (extremely thick), and foods are measured from level 3 (liquidized) to 7 (easy to chew). The system also describes tests that providers, patients and caregivers can use to confirm the characteristics of a food or beverage. So if someone is asked to prepare cooked carrots “soft and bite-sized,” there’s a test to make sure that’s how the carrots are served.

The initiative is based on scientific evidence and endorsed by health organizations across the globe. Companies that make special foods and beverages for people with dysphagia are using the system on labels. This will be helpful for patients and families who purchase products after returning home from an inpatient stay.

How does the new system benefit patients?

The new system is culturally sensitive, measurable and applicable to individuals of all age groups in all care settings. It uses terms that are universally understood, such as “slightly thick” and “easy to chew,” rather than terms that not everyone can grasp, such as “honey thick.”

The system makes it easier for providers to teach people how to test their food using chopsticks, fingers, or forks. There are “how-to” videos online that demonstrate the different techniques.

Introducing this system at Providence must have been a big undertaking.

That’s right. Providence is such a large organization with multiple locations in seven states. We had to retest every food item in our kitchens and relabel everything to the appropriate level. We provided training for everyone who would use the new system, including speech language pathologists, dietary and food services staff, physicians and nurses. I think we are the largest organization in the United States to adopt the IDDSI all at once. It will be worth the effort because it improves safety for people – our patients and those worldwide – with dysphagia.

Are there other strategies to help people with dysphagia manage swallowing difficulties?

Speech language pathologists can teach them exercises and posture techniques to improve swallowing, as well as provide a personalized diet. The first step is to have a thorough evaluation.


Find a doctor

If you or a loved one has a swallowing disorder, the Providence speech language pathology providers can help you with guidelines for food preparation using the new standard. Find one in our provider directory

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Related articles

The International Dysphagia Diet Standardisation Initiative

Malnutrition in older adults

This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

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From how to identify and treat heart diseases to exercise tips to maintain an active lifestyle, the Providence Senior's Health team is committed to providing real-world advice that is hyper-relevant to helping those 65+ find ways stay young at heart

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