Conscious level
No one should be given food or drink if unconscious or semi-conscious. Alternative
nutritional and hydration options should be discussed with the responsible clinician.
Distraction
Reduce distractions at mealtimes to facilitate concentration and awareness. This should
include reducing chat and the resident should not be encouraged to talk/respond when eating or drinking. The reason for this should be explained to the resident and their family as appropriate.
Time
Allow adequate time to support the individual to eat and drink. Consider the use of insulated containers to maintain the temperature of food for those people whose mealtimes may be prolonged.
Positioning
People should sit upright for all snacks, meals and drinks. People should remain sitting
upright for at least 30 minutes after a meal to avoid reflux.
Oral hygiene
It is of key importance to note that people with eating and drinking difficulty often
have poor oral hygiene which can lead to greater incidence of chest infections. Ensure the mouth is mclean and free from residue at the end of the each meal. Encourage a ‘clearing swallow’ or ‘saliva swallow’ to assist in clearing residue from the mouth. Cleaning teeth and the mouth at intervals during the day is advocated.
Position yourself
Position yourself at eye level so that you may observe signs of difficulty or aspiration as well as being able to provide verbal prompts and encouragement. Positioning yourself above eye level or sitting at the side of individuals to assist with eating and drinking may have a negative impact on the individual’s ability to swallow safely as they may change their posture.
Utensils
Ensure you have the correct utensils identified for the individual to facilitate a safer swallow and to improve sensory awareness.
Glasses and hearing aids
Swallowing requires multi-sensory stimulation. Food should be visually appetising in its presentation and smell appealing in order to stimulate the appetite (and thus salivary flow) as well as increasing the amount taken. Ensuring that the resident can hear the guidance and advice being given e.g. when prompted to slow down. Therefore, hearing aids and glasses need to be available and fit comfortably.
Dentition
dentures, if worn, should fit well. Be aware that some individuals prefer to eat without
their dentures and softening the diet may help.
Modifying diet
ensure the correct consistencies of food and drink are given to the resident with
dysphagia. More information about food textures advised by Speech and Language Therapy can be found at www.iddsi.org which is the website for the International Dysphagia Diet Standardisation Initiative.
Author: Speech and Language Therapy, January 2019. Adapted from Royal College of Speech and Language Therapists Guidance on the Management of Dysphagia in Care Homes . Review date: January 2020.
Independence
Residents should be encouraged to feed and drink themselves where possible to
encourage and maintain functional independence. Vary the amount of assistance according to individual need (verbal prompts, loading spoon, hand over hand feeding).
Portion size
People who are frail or lack stamina should be given small portions which require less
energy to eat (for example softer and/or more moist foods). These small portions of food or drink should be given at more frequent intervals in the day. Oral intake charts should be completed to ensure the person receives adequate nutrition and hydration.
Size of mouthful
Experimenting with the preferred size of mouthful is important. It should be
sufficient to stimulate chewing and swallowing but it is important to avoid overlarge mouthfuls.
For further advice, or to arrange discussion about a resident please contact Adult Speech and Language Therapy on 01642 854497.