MODULE 1: METHODOLOGY AND TOOLS DEVELOPMENT FOR ADULT EDUCATORS

• Many ingredients that are hard when raw become softer after cooking. They should be cut up across the grain, and cooked until they are sufficiently soft.

• Dry ingredients can have liquid or fat added to make them softer and smoother.

• Potatoes and eggs may have a binder added to soften them and make them hold together more easily.

• The savory taste of protein foods is drawn out when they are cooked at a low temperature for a long time, and this method also enables them to be cooked without excessive loss of water content.

• Raw vegetables are difficult to eat, and thus should be cooked. Salads should consist of steamed or dressed dishes.

Preparation

• Adding liquid: Too low water content makes food difficult to swallow, but when too high, it can cause choking.

• The right amount of liquid should be added in preparing food so that it is soft and easily taken in.

• Liquid should be added to chopped boiled green vegetables, and they should be boiled until soft.

• For example, bread can be made into French toast, and steamed fish substituted for grilled fish.

• Adding a binder: Make mince into meatballs (with added egg) or hamburgers.

• Ways of cutting food: If the first one or two bites are difficult, rather than chopping food up finely, score it or make cuts at narrow intervals most of the way through. Thin foods are difficult to perceive in the mouth, so it is better to cut food to a thickness of 5–10 mm and cook it until soft. Check the direction in which the fibers run and cut them up across the grain, as this makes the cooked food easier to chew.

• Adding fat (salad oil, mayonnaise, butter, cream, etc.) to food makes it smoother and easier to swallow. Generally speaking, fish or meat with a high fat content does not harden after cooking, and is easy to eat.

• For example, mashed potatoes or sweet potato cakes should be served rather than steamed potatoes.

Temperature

• The temperature of food should be around 20ºC above or below body temperature. This difference between body temperature and food temperature provides a stronger stimulus that is more likely to trigger the swallowing reflex.

• This reflex is most likely to be triggered when the pharyngeal mucosa is touched by something slightly cold.

• A temperature of around 10ºC–15ºC also feels pleasant in the mouth, thus promoting ease of eating.

• When preparing meals with more than one component (e.g. meat, potatoes and carrots), purée the foods separately and arrange them on the plate separately. This means that the flavour and the colour of the individual foods are maintained much as they are in a normal meal.

• Foods and drinks thickened can be chilled, frozen and reheated. Many people find it easy to make batches of food they eat relatively often and freeze the extra portions for later use (if you freeze the food in ice cube trays, it allows easy control of portions as you need only defrost and reheat as many cubes as you need for each meal).

• Bread and other foods made with grain, such as biscuits and cakes, are a particular problem for patients with dysphagia. The granular structure of these foods means that they are extremely hard to swallow. Using soaking solutions can help you achieve a smooth texture with these foods.

Bread in Modified Texture Diets

• Gelled soaked breads and cakes are listed in the standards as suitable for Level 7 Regular Easy to Chew, Level 6 Soft Bite-Sized and Level 5 Minced & Moist diets.

• The bread sandwich recommendations are to use the soaked bread methods or gelled bread methods (using the Shape It product with soaked whole bread but also with bread processed into fine crumbs for safety). The method on the IDDSI website is to finely chop the bread, add an equal amount of water and margarine or butter; mix, making it into a shape and serving. This saves the worry that the soaking is not complete, as any thickening products used, thicken quite quickly, but can leave dry sections which are not soaked.

• Top with a finely chopped or blended egg/mayonnaise or tinned fish/tartare sauce, paté or cream/feta cheese mix. The fillings can be adjusted to suit the diet requirement. The combination of water and fat reduces the stickiness of the bread and improves bolus cohesion. It can be eaten with a fork or spoon unless served as a finger food.

• Always test for suitable textures having a focus on dryness and or stickiness.