Smaller plates for smaller portions

The amount of food you serve should be appropriate for each individual.

The use of small plates can aid in an individual’s motivation to eat. An over-large portion for the individual on a large plate can put the patient off attempting to eat the food.

Seeing a small plate of food can seem more manageable, and it is our goal to make sure the patient’s are comfortable when eating. Something as simple as using a smaller plate can encourage a patient to eat.

As a person nears the end of their life, their metabolism slows down and their body no longer needs food, as it can’t digest it well or absorb the nutrients from it. At this stage, it’s important the person doesn’t force themselves to eat, and it’s okay if they don’t. The ability to eat and drink may be lost in some conditions and the patient may require additional support.

Food dense in calories is often poorly absorbed and may produce diarrhoea, causing discomfort and distress to the patient.

The normal swallowing process is controlled by the swallowing reflex. Swallowing, is the process by which fluid or food is transported from the mouth to stomach for digestion. If this mechanism fails and the bolus is misdirected into the airway, then choking or pulmonary aspiration may occur.

When the process of swallowing is disrupted the risk of aspiration increases greatly. Aspiration has very serious health implications, and if not managed properly can result in respiratory tract infections.

Other risks to health linked to Dysphagia are malnutrition, dehydration and asphyxiation. Swallowing problems can involve the oral cavity, pharynx, larynx and/or oesophagus.

Patients may need assistance to help them swallow and their food will need to be prepared so they can swallow without it causing distress.

Food and fluid consistency

Thickened fluids are often used for people with Dysphagia. The thicker consistency makes it less likely that an individual with Dysphagia will have fluids from the gastrointestinal tract passing into the larynx and lower respiratory tract while they are drinking.

Below are the recommended modified consistencies by Speech and Language Therapists.

LIQUIDISED A thin liquid of a single consistency, with no lumps.

THIN PUREE : A moist, smooth consistency which does not require chewing and cannot be eaten with a fork. There are no bits or lumps and it does not hold shape. A thin puree should have a consistency like thick double cream.

THICK PUREE/ SMOOTH: A moist, smooth consistency, like a mousse, which does not require chewing. There are no bits or lumps, and it should be thick enough to form furrows with the prongs of a fork. A thick puree can be piped or moulded. Food moulds can be used to help shape puree and mashed food to enable it to look like a natural meal which is more appetising.

PRE-MASHED: A moist, fork-mashable diet which has been ready mashed before the person eats, should require very little chewing. A pre-mashed meal must be well mashed, and in acute hospitals this may come ready prepared. In other locations the food must be mashed well with the client before eating, and gravy may be added as appropriate.

FORK-MASHABLE: These are soft, tender, moist foods that require some chewing by the patient. Pieces of meat must be no bigger than 1.5 cm, and the meal should be mashable with a fork. Tender casserole meats may be suitable.

Fork-mashable meals usually require a thick sauce and should have no stringy, dry, crispy or crunchy bits. There should also be no skin, bone, gristle, seeds, pips or shells.

SOFT OPTIONS FROM NORMAL MENU: These are soft foods, which may include fork-mashable meals, but also include soft sandwiches with moist fillings and the crusts removed. These foods require the person to have reasonable chewing and the ability to clear the mouth.

Soft options from the normal menu can be suitable for people with no teeth or more mild swallowing difficulties.

NORMAL DIET: A normal diet includes all foods from a normal menu. People who can manage sweets, crisps, dry and chewy foods will be on a normal diet. If someone is progressing from a soft diet to a normal diet it is important to monitor what they can manage.