Speech and Swallowing Team - Information for Care Homes

Who are the Speech and Swallowing Team?

We are a team of Speech and Language Therapists (also known as SLTs or SALT) who specialise in assessing and providing intervention for those with swallowing and/or communication difficulties.

• QDysphagia Information

  What is Dysphagia?

  Dysphagia is a disorder of swallowing.

  People with dysphagia may have difficulty holding food or fluid in their mouth, chewing, moving food to the back of the mouth, swallowing at the right time, protecting the airway when swallowing, clearing food from their throat or getting food or fluid to pass down in to the food pipe.

  Why does it happen?

  Dysphagia can happen if there is damage to the muscles used for swallowing, or if a person becomes less aware of what is in their mouth.

  Dysphagia can be caused by stroke, head injury or other neurological conditions - including Parkinson’s Disease, Multiple Sclerosis and Motor Neurone Disease. It can be caused by some respiratory conditions.

  Why is dysphagia a problem?

  People with dysphagia are at higher risk of food or fluid going down the wrong way (i.e. going into the lungs instead of the stomach). This is known as aspiration. Aspiration can cause chest infections and pneumonia.

  Swallowing difficulties can lead to malnutrition and dehydration if they are not managed properly.

  Will it improve?

  Improvement and recovery will vary from person to person and can be difficult to predict. Your speech and language therapist will be able to discuss this with you in more detail.

  Symptoms of dysphagia

  • Coughing or choking on food or drink
  • Wet / gurgly voice after swallowing
  • Shortness of breath after swallowing
  • A feeling of food sticking in the throat
  • Difficulty chewing food
  • Food or drink residue left in the mouth
  • Loss of appetite or reluctance to eat certain things
  • Serious weight loss
  • Repeated chest infections

  What can help with swallowing?

  • Sitting as upright as possible when eating and drinking (not leaning forward, back or to one side) - ideally in a chair.
  • Avoid tipping your head back to swallow.
  • Take small mouthfuls of food or drink.
  • Eat and drink slowly and leave plenty of time between mouthfuls.
  • Chew food thoroughly and carefully.
  • Don’t eat or drink if you’re feeling too tired or unwell - wait until later.
  • Try not to mix mouthfuls of food and drink together.
  • Don’t talk whilst eating or drinking.
  • Avoid distractions e.g. TV / radio if this stops you following the advice above.
  • Don’t use spouts or straws, unless they’ve been specifically recommended.
  • If you have dentures, make sure they fit properly. If not, try a fixative- and wear them, if comfortable, to help with chewing.
  • Try to stay sitting upright for at least 15 minutes after eating or drinking.

  Who can help?

  Speech and language therapists are trained to assess swallowing.

  Your speech and language therapist can recommend food and drinks that are safe to swallow. It may be beneficial to have a modified diet or thickened fluids.

  If your swallowing is unsafe, it may be necessary to remain nil by mouth (NBM). Your doctor may recommend that you have a temporary nasogastric feeding tube (NG tube).

  Other members of the team can also help:

  • Dieticians may help to ensure nutrition and hydration is adequate.
  • Physiotherapists may help with sitting position.
  • Occupational therapists may suggest ways to help you eat and drink.
  • Nurses may assist with eating and drinking and with keeping the mouth and teeth clean and healthy, particularly if you are NBM.
  • Pharmacists may suggest medicines are given in a different form e.g. syrups rather than tablets.
• QReferral Guide for Care Homes

  Swallowing difficulties (dysphagia)

  Dysphagia is a disorder of swallowing.

  People with dysphagia may have difficulty holding food or fluid in their mouth, chewing, moving food to the back of the mouth, swallowing at the right time, protecting the airway when swallowing, clearing food from their throat or getting food or fluid to pass down into the food pipe.

  Referrals

  The Speech & Swallowing Team receive a very high number of referrals for people with dysphagia. It is important that the referrals we do receive are appropriate for our service to ensure that those who will benefit from our input are seen as soon as possible.

  Referral criteria

  Speech and Language Therapists (SLTs) are specialists in oropharyngeal dysphagia. Oropharyngeal dysphagia describes swallowing difficulties occurring in the mouth and/or the throat.

  Please refer anyone with signs of dysphagia such as:

  • Coughing or choking on food or drink
  • Wet/gurgly voice after swallowing
  • Shortness of breath after swallowing
  • A feeling of food sticking in the throat
  • Difficulty chewing food
  • Food or drink residue left in the mouth
  • Reluctance to eat certain textures of food
  • Serious weight loss
  • Repeated chest infections

  Definition of choking: 

  - Severe choking:  Where choking is severe; the person will not be able to speak, cry, cough or breathe. Without help, they'll eventually become unconscious. Requires back slaps and abdominal thrusts to clear. 

  - Mild choking:  If the airway is only partly blocked, the person will usually be able to speak, cry, cough or breathe. They'll usually be able to clear the blockage themselves.

  Referrals considered inappropriate:

  Presenting symptom	Reason a referral would not be appropriate
  Residents who have a “one-off” eating/drinking difficulty e.g. a single coughing or choking incident with no further signs of dysphagia	Anyone can experience a one-off swallowing difficulty at any time e.g. when rushing food or when talking with food in the mouth. If someone has a one-off difficulty, it would be advisable to supervise eating/drinking to look out for any other signs of dysphagia.
  Poor appetite, weight loss or refusing to eat with no signs of swallowing difficulties	If you are worried about weight loss, the resident may benefit from input from a Dietitian. However, if the resident is avoiding specific foods, a referral to our service may be appropriate.
  Pain when swallowing with no other signs of swallowing difficulties	The resident should be seen by a GP as this is a medical issue. A referral to ENT may be appropriate.
  Difficulties swallowing tablets but eating/drinking with no signs of dysphagia	This issue can be spoken about with a GP/Pharmacist to discuss modifying medications to an alternative form. If there are no difficulties with food and drink, this would not indicate an oropharyngeal dysphagia.
  Oesophageal swallowing difficulties with no oropharyngeal component. For example, vomiting after eating or acid reflux	Residents should be seen by a GP where treatment options can be considered and/or onward referral to gastro or other services.
  Residents known to be eating/drinking with acknowledged risk of aspiration with no change to their condition/presentation/situation	The risk of aspiration has already been acknowledged and signs of aspiration (including repeated chest infections) are to be expected. Further input is unlikely to be beneficial for these residents. However, please refer if there has been a change to their presentation and/or situation, e.g. increased distress.

  If you have any concerns or would like to discuss a referral, please contact the Speech and Swallowing Team.

• QLevel 7 Easy to Chew Diet Information

  What is easy to chew?

  “Easy to chew” is a subcategory of level 7 (Normal/regular texture food) and describes foods that are “soft” with no restrictions on the size of food pieces. This level is suitable for individuals who have the ability to regulate bite size and pace of eating.

  Foods should be soft and tender.

  Food can be cut or separated easily with the side of a fork or spoon.

  Foods do not need to be cut or presented in any specific sized pieces.

  Difficult foods

  Some foods are very difficult to chew or swallow. These foods need to be avoided. Speak to your Speech and Language Therapist about these.

  Mixed consistencies Solid foods with thin liquid. E.g. Soup with food pieces, hard cereal with milk

  Hard foods E.g. Nuts, boiled sweets

  Fibrous or stringy foods E.g. beans, pineapple, rhubarb

  Juicy food Where juice separates off in the mouth E.g. watermelon, oranges

  Chewy foods E.g. chewy sweets, chewing gum, dried fruit

  Crispy foods E.g. crisps, flaky pastry, crispy bacon

  Crunchy foods E.g. raw carrot, raw apple, popcorn

  Crumbly foods E.g. biscuits, pie crust, dry cake

  Pips, seeds and pith E.g. apple seeds, orange pith

  Skins and outer shells E.g. peas, grapes, beans with tough shells

  Skin, bone and gristle E.g. chicken skin, fish bones

  Round or long shaped foods E.g. sausages, grapes, sweets

  Sticky food E.g. marshmallows, some cheese, peanut butter

  Floppy food E.g. lettuce, cucumber, salad leaves

• QLevel 7 Easy to Chew Meal Ideas

  Level 7 Easy to chew

  • Foods should be soft and tender
  • Foods can be cut or separated easily with the side of a fork or spoon
  • Foods do not need to be cut or presented in any specific sized pieces

  Please be aware: This following is intended to give you examples of food that would be suitable for a level 7 easy to chew diet. It is not intended as a meal planner. Please discuss with your SLT or dietitian if you need any further ideas/options.

  Breakfast

  • Porridge
  • Weetabix
  • Cereals softened with milk
  • Scrambled eggs/omelette
  • Yoghurt
  • Pancakes
  • Boneless mackerel/kippers
  • Avocado
  • Lightly toasted toast (softened with butter/may need crusts removed)

  Mains

  • Fish pie, fish in sauce, fish cakes
  • Casseroles or stew
  • Shepherd’s pie / Cottage pie
  • Corned beef hash
  • Pasta-well cooked (e.g. Gnocchi, Ravioli, Lasagne, Bolognese, Macaroni cheese)
  • Moussaka
  • Curries / dahl
  • Risotto
  • Omelette
  • Meatballs
  • Burger
  • Sausages (skins removed)
  • Noodles
  • Omelette
  • Jacket potato (insides only) with soft filling
  • Sandwiches with soft filling (e.g. tuna/egg mayo)

  Vegetables

  • Softly boiled vegetables without skins (e.g. carrots, turnips, parsnips, sweet potato, cauliflower, courgettes, beetroot etc)
  • Mushy peas
  • Soft potatoes (mashed, boiled, roasted or chipped-if not too crispy and hard, add gravy or sauce if needed)

  Sauces (to improve texture and flavour)

  • Gravy
  • White sauce, parsley sauce
  • Mayonnaise, salad cream, sour cream
  • Houmous, guacamole
  • Tomato ketchup, brown sauce

  Desserts and Snacks

  • Fresh or tinned soft fruit e.g. mango, strawberries, pears, peaches
  • Stewed hard fruit with skins removed and excess juice drained
  • Banana
  • Chocolate mousse or smooth chocolate puddings
  • Trifle
  • Milk puddings (e.g. rice pudding, semolina, tapioca)
  • Cake / sponge pudding (may need cream/custard)
• QE-Learning Resources

  Dysphagia Guide E-learning Resource

  A free dysphagia e-learning programme to support health and care staff: https://www.e-lfh.org.uk/programmes/dysphagiaguide/

  There are six separate sessions:

  • Essentials for Health and Care Staff
  • Essentials for Cooks
  • Managers
  • Balancing Risk and End of Life Care
  • Training Resources and Recipes
  • Dysphagia and Medicines

  This may be useful for care home staff, including managers, nurses, care workers, catering staff and the wider NHS team.

Referrals 

Click here to complete a referral form.