The Dysphagia Dilemma - Why we need to improve the offering of nutritional, texture-modified foods

With approximately 670,000 Australians experiencing a daily battle when it comes to swallowing food, many are missing out on the joy of mealtimes.

Known as Dysphagia, the swallowing impairment is a common consequence of well-known health conditions like stroke, Motor Neurone Disease, Parkinson’s Disease, and head and neck cancer. With these conditions usually experienced among people aged 70 years and above, Dysphagia is an ongoing concern for our ageing population. 

And it comes with a price.

Recent research from Flinders University found people with Dysphagia usually have a slower recovery, staying up to three days longer in hospital and costing the healthcare system 40% more than those without impaired swallowing. 

The reason? Malnutrition and dehydration caused by incorrect preparation and delivery of texture-modified food.

The Dysphagia Dilemma

When diagnosed with the condition, dieticians, speech pathologists, and other health care professionals step in to advise patients and carers on the International Dysphagia Diet Standardisation Initiative (IDDSI) level required for the severity of the patient's condition. There are 7 levels of 'liquid thickness' measurement or Food Textures involved - with 1 being slightly thick through, 3 being liquidised, and 7 being easy to chew.

However, in the process of ensuring food is modified and drinks are thickened for safe consumption, the flavour, appearance, and nutritional aspects are often lost or neglected. 

And this is where malnutrition and dehydration comes in. Because, after all, who wants to eat unappealing food?

The enjoyment of food through taste and smell is arguably even more important than the nutritional value. It stimulates memories and improves their overall sense of wellbeing. These factors are often pushed aside in the attempt to prepare appropriate texture-modified food.

Accredited Practicing Dietitian, Linda Cumines, says it’s the carers’ responsibility to also ensure texture-modified options look appetising. “If food has lost its shape or is filled with too much fluid, it affects the sensory experience and can lead to the avoidance of food altogether.”

The Dietitians Association of Australia estimates between 22% and 50% of older people living in residential care are malnourished. The stats speak for themselves - this is an area that requires urgent attention. 

Enjoyable, nutritious food is a must 

As highlighted in the 2021 Final Report by the Royal Commission into Aged Care Quality and Safety, diet, nutrition, and food are critical to the health and wellbeing of older people. Food must meet the body’s needs to maintain organs and body systems, repair injury, fight off or recover from illness or infection, and maximise physical and cognitive capacity. 

When there’s poor quality, low variety, and unappetising food on the table - and a lack of assistance to eat and drink - malnutrition and dehydration becomes an area of concern. And this malnutrition can lead to an increase of falls and fractures, injury healing time, risk of infection, and unnecessary hospitalisation. That’s related to the ageing population in general. For those experiencing Dysphagia, circumstances are even worse.

The pressure on carers

According to consumer data collected by Care Food Co, 60% of carers report they’re not happy with the texture-modified foods they’re serving.  And in many cases it’s not their fault. 

Due to the subjective nature of the IDDSI Framework and the provision of unclear, confusing instructions, producing adequate food levels is often problematic. There’s also no available equipment designed to comply with the IDDSI levels, meaning many carers rely upon traditional blenders for food preparation.

As a result, many aged care providers are choosing to seek external suppliers, like Care Food Co, for tasty and nutritious products that meet the IDDSI framework. The company uses High Pressure Processing (HPP) technology to improve the bioavailability of the food - aka the ability to be absorbed and effectively used by the consumer’s body. 

Dr Simon Little from Quality Food Systems Pty Ltd strongly recommends cold pasteurisation via the HPP process to ensure nutrition for people with Dysphagia. “When your appetite and ability to swallow is limited, every mouthful counts. Cold pasteurisation technology is proven to enhance the bioavailability of organic nourishment, so there’s no need to add extra ingredients for their nutritional value. The optimal nutrition comes naturally.”

Creating a joyful mealtime experience

Amanda Orchard from the Institute for Nutrition at Edith Cowan University understands the importance of providing Dysphagia patients with flavoursome texture-modified foods. 

“In most aged care settings, the whole day is structured around mealtimes. It’s something every resident looks forward to. As a carer, it’s so rewarding to see them enjoy their meals and the smile that spreads across their face. Having a flavourful, nutritious, and enjoyable dining experience is important for their overall health and wellbeing.” 

Everyone deserves to enjoy food. Especially people with Dysphagia. 

If you’re keen to provide fresh, tasty, and nutritional texture-modified food to your residents, it’s comforting to know companies like are there to support you.