Australia moving to international dysphagia diet terminology
The International Dysphagia Diets Standardisation Initiative (IDDSI) Framework uses standardised terminology, labelling and testing methods to improve safety and reduce choking and aspiration risks for people with dysphagia.
The International Dysphagia Diets Standardisation Initiative (IDDSI) Framework uses standardised terminology, labelling and testing methods to improve safety and reduce choking and aspiration risks for people with dysphagia. The new IDDSI Framework came into effect in Australia on May 1, 2019. The implementation is supported by the Australian IDDSI Steering Committee that includes representatives from Speech Pathology Australia, the Dietitians Association of Australia, the Institute of Hospitality in HealthCare, IDDSI international and industry.
Dysphagia is listed by the World Health Organisation in both the International Classification of Diseases (ICD-10) and the International Classification of Functioning Disability and Health. Dysphagia can occur at any time during the lifespan, may be short or long term and conservatively affects about eight per cent of the population. The most common causes of dysphagia are related to underlying medical or physical conditions such as prematurity of birth, cerebral palsy, head injury, cancer of the head and neck, stroke, dementia, psychological or psychiatric conditions and other conditions. Dysphagia affects 30 to 50 per cent of residents in aged care facilities. Although choking risk is well recognised in young people, it less well known that the incidence of choking on food is seven times greater for people over the age of 65 years than it is in children aged 1 to 4 years1.
To reduce choking risk foods may be pureed, minced or chopped, and drinks may be thickened. The NSW Ombudsman’s report into Reviewable deaths of people with Disability in Residential Care (2012-2013 and 2014-2017), recommends that to reduce preventable deaths there must be improvement in identification and management of swallowing and choking risks, and better communication about food textures that are safe for people with dysphagia to eat. The term ‘soft diet’ in particular has caused confusion amongst health and care workers and has resulted in choking deaths across Australia2.
The Australian Standardised Terminology for Texture Modified Foods and Fluids were introduced on a voluntary basis in 2007. Until the development of the IDDSI Framework in 2015 some countries used national terminologies, while others had no national strategy. As such, texture modified foods or thick drinks could be called and labelled at one level in Australia and quite differently in other countries. The adoption of international standards supports person-centred risk management of dysphagia, and provides a common language for technical, cultural, professional and non-professional uses. As with adoption of the Australian Terminology in 2007, transition to the IDDSI Framework is also voluntary. Many hospitals, health care professionals, aged care organisations, disability providers, community groups and industry are in the process of getting ready to move to IDDSI from May 1, 2019.
Major changes from the Australian terminology to the IDDSI framework include a new numbering system, colour code changes denoting the thickness of drinks, and the removal of bread and sandwiches from the new IDDSI Level 6 Soft & Bite-Sized (Australian Texture A Soft). This follows the international standard not to include bread and sandwiches on the Level 6 Soft & Bite sized diet as it poses an extremely high choking risk based on summaries from international coronial inquests and autopsy data, and reports such as the NSW Ombudsman’s 2012-2013 report2,3,4.
For more information about IDDSI, to download consumer handouts or learn more about the initiative visit the IDDSI website (https://iddsi.org/) or contact the Australian IDDSI Project Office Dr Julie Cichero at firstname.lastname@example.org.
Dr Julie Cichero (PhD)
On behalf of the Australian IDDSI Steering Committee
- Kramarow et al. (2014). Food related choking deaths among the elderly, Injury Prevention http://dx.doi.org/10.1136/injuryprev-2013-040795
- NSW Ombudsman (2015). Report of Reviewable Deaths in 2012 and 2013. Volume 2: Deaths of people with disability in residential care. Crown Copyright, NSW Ombudsman
- Berzlanovich, et al. (2005). Foreign body asphyxia: A preventable cause of death in the elderly. Americal Journal of Preventative Medicine, 28: 65–69, doi:10.1016/j.ampere.2004.04.002.
- NSW Ombudsman (2018). Report of Reviewable Deaths in 2014 and 2015; 2016 and 2017.: Deaths of people with disability in residential care. New South Wales, NSW Ombudsman.
Published: 03 May 2019