International Dysphasia Diet Standardisation Initiative IDDSI What IDDSI

International Dysphasia Diet Standardisation Initiative (IDDSI)

What? IDDSI Framework The goal of IDDSI was to develop a new global standardised terminology and definitions to describe texture modified foods and thickened liquids used for individuals with dysphasia of all ages, in all care settings, and all cultures.

Why? v v Dysphasia diet standards have been developed at regional and national levels. Unfortunately, different terminologies, labels, numbers and levels are used in these standards: ü v v v Based on the survey, there are 54 different names for honey thick and pureed meals Adds to the confusion for individuals and caregivers as well as health professionals and researchers Giving wrong texture of foods can put people with dysphasia under a high risk of choking and aspiration! Aspiration can be silent in senior population !!! Aspiration Pneumonia Death!!!!

Where is IDDSI being implemented? v North America: United States and Territories, Canada v South America: Brazil v Europe: Belgium, Denmark, France, Germany, Ireland, Norway, Poland, Slovenia, Sweden, Turkey, United Kingdom, The Netherlands v Asia: China, Japan, Thailand v Australia, New Zealand v Middle East: Israel v South Africa

Canada v Implementation discussions are currently underway across Canada in several Health Authorities and regional groups Aware Jan 1, 2017 Prepare Jan 1, 2018 Adopt Jan 1, 2019 v Pilot underway in New Brunswick v IDDSI framework and descriptors are being incorporated into university curricula and incorporated into PEN (Practice-based Evidence in Nutrition)

2 3 4 International Dysphasia Diet Standardisation Initiative (IDDSI) 5 6 7

0 -THIN Regular ex: water, boost ex: water 1 -SLIGHTLY THICK Slightly thicker than water ex: tomato juice, Ensure Enlive

Water Tomato Juice

IDDSI Flow Test Luer Tip Length of scale = 61. 5 mm

0 -THIN ex: water IDDSI FT: <1 ml Regular Drink ex: water, boost 1 -SLIGHTLY THICK Slightly thicker than water IDDSI FT: 1 -4 ml ex: tomato juice, Ensure Enlive

2 2 -MILDLY THICK IDDSI FT: 4 -8 ml Nectar Thick Drink Ex: eggnog, buttermilk

3 3 -MODERATELY THICK/LIQUIDISED ü Smooth texture with no ‘bits’ ü Liquid must NOT separate from solid IDDSI FT: >8 ml Fork Drip Test: Drips slowly in dollops through the prongs of a fork Fork Pressure Test: NOT leave a clear pattern ex: fruit syrup Honey Thick Drink Ex: gravies , sauces *Liquid Meal/Meat (1)

Fork Drip Test Sits in a mount or pile above the fork Drips slowly or in dollops through the tines of a fork 3 -Liquidised/Moderately Thick 4 -Pureed/Extremely Thick

Fork Pressure Test 3 -Liquidised/Moderately Thick 4 -Pureed/Extremely Thick Fork can NOT leave a clear pattern on the surface Fork can leave a clear pattern on the surface

4 4 -EXTREMELY THICK/PUREED üCan not be poured üSmooth with NO lumps üNOT sticky üLiquid must NOT separate from solid Pudding Thick Drink Ex: pudding, yogurt Puree Meal IDDSI FT: Not applicable *Pureed dessert (3) Fork Drip Test: *Pureed soup (3) Sits in a mound/pile above the fork (may with tail) Fork Pressure Test: Can make a clear pattern on the surface ex: thick cereal, pudding

Pudding Thick Apple Juice made with Simply. Thick® Imperial SYSCO Honey Thick Orange Juice

5 5 -MINCED&MOIST (Particle Size: 4 mm) üMinimal chewing is required üNO separate liquid should be seen Fork Pressure Test: -Particles can easily come through two tines of a fork -Can be easily mashed with little pressure (NOT make thumb nail blanch) Ground/Minced Meal -Resemble ground beef -Exceptions: regular soup, fish (no breading, serve as whole) -Bread may or may not be allowed 4 mm

Fork Pressure Test 4 mm

6 6 -SOFT&BITE-SIZED (Particle Size: 15 mm) No separate liquid should be seen Fork Pressure Test: -Fork can be used to cut this texture into small pieces -When a sample is pressed with the base of a fork to a pressure where thumb nail blanches to white, the sample squashed and changes shape *Ground Meal -Ground meat -Cooked soft vegetable and fruit (size may vary) (no raw vegetable, hard fruit, crackers/cookies)

Fork Pressure Test 15 mm Thumb nail blanches to white

Fork Pressure Test 4 mm √ 5 -Minced&Moist (4 mm) × 6 -Soft&Bite-Sized (15 mm)

Level 6 – chicken and vegetables Level 4 - goats cheese, beetroot and apple

7 *Cut Up Meal Normal, everyday foods of various textures -All meats are cut up into bite-size pieces by nursing staffs (size may vary) -Regular vegetables and fruit 7 -REGULAR General/Regular Meal

TRANSITIONAL FOODS (5&6&7) üStarts as one texture (e. g. firm solid) üChanges into another texture when moist and heat applied (imitating the month environment) Fork Pressure Test: 1. Place 1 ml of water on a sample (ex: 1. 5 cm*1. 5 cm) 2. Wait 1 minute 3. Apply fork pressure using the base of the fork until the Ex: ice chips, ice thumb nail blanches to white 4. The sample should no longer looks like its original state: cream, wafers, waffle cones - Squashed and disintegrated - Melted significantly

Transitional Foods Firm Solid Moist + Heat + Time Easily Mashed

15 mm 4 mm

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Thank you for listening !

http: //iddsi. org/