Helping Those with Dysphagia at Mealtimes
Helen Willis, Wiltshire Farm Foods Dietitian.
For someone living with dysphagia, the enjoyment of mealtimes can be completely diminished. Eating can become a difficult, uncomfortable and stressful experience and a consequence may be that sufferers avoid eating altogether. Therefore, the challenge healthcare professionals face in dealing with dysphagia is often twofold; they must ensure patients receive the correct nutrition through meals of the right texture, whilst encouraging them to eat in the first place.
To achieve this, there are several elements to be considered. Firstly, a healthcare professional tasked with helping a patient with dysphagia to eat well, must ensure their diet is of the appropriate texture. As dysphagia is a dynamic condition, there is no such thing as a one-time diagnosis. There is likely to be deterioration, or alternatively, when the patient has suffered a stroke for example, there is often improvement. Speech and Language Therapists should frequently assess the patient, then work together in a multidisciplinary team to ensure the safest diet. Once this is achieved, the patient can be more confident in the safety of their meals; a crucial step towards reducing the stress experienced at mealtimes.
Further elements to be considered are the visual presentation and taste of the food offered. The nutritional value of a meal left uneaten is zero, so it is essential meals are presented in an appealing manner. Blending all the components of a meal together is often the process followed to make a meal ‘safe,’ but serving a meal like this can be unappealing to the patient. Each component of the meal should resemble its original form - foods should be blended separately and moulds used when possible. Making meals recognisable is especially important for those living with dementia, which commonly presents with dysphagia.
The importance of food that tastes good should never be overlooked. When blending food together, water and other liquids are often added to achieve a good consistency, but this can impact on taste. Ensuring food tastes delicious and offering plenty of options which take preferences, dietary and cultural requirements into account is a vital part of helping patients to eat.
Healthcare professionals must also focus on recommending a diet which meets the patient’s nutritional needs. Those with dysphagia often have reduced appetite and are at risk of malnutrition; it’s crucial, therefore, that their food contains the appropriate nutritional content, often needing to be high in calories and protein. Dietitians should assess each individual patient, monitor their nutritional intake and advise accordingly. Knowing that the food they are eating is part of their treatment may encourage patients to finish their meal.
A final element which is often overlooked is the dining experience. Whether at home, in hospital or in care, the patient’s dining environment should be pleasant and comfortable. Case studies often describe patients who choose to dine alone, as they are too ‘embarrassed’ to eat in front of family. This problem is exacerbated when eating out in public. A fear of choking and coughing, or of being unable to eat their meal with dignity, leads individuals to report that they avoid social dining altogether. However, research has shown that being part of a group is a rewarding experience. Eating with others also enhances our enjoyment of food. So, you could say that getting the patient to eat with others can be as important as adding more nutrients to their diet. As well as helping them to eat amply and healthily, a social situation stimulates the mind and makes mealtimes more enjoyable. Therefore, healthcare professionals should take it upon themselves to encourage patients to dine with family and friends or attend lunch clubs whenever possible.
Helping individuals to have confidence in the safety of their diet and encouraging them with ways of creating great tasting, nutritional meals to enjoy in a pleasant environment, are steps a healthcare professional can take to improve the overall wellness and health of their patient.
 The Knowledge - Dysphagia: The Hard to Swallow Truth, p.7
 Suzanne Higgs and Jason Thomas, ‘Social Influences of Eating’, in Current Opinion of Behavioural Sciences, (2015)