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Global initiative aims to improve safety for residents with dysphagia

The implementation of a new international framework for naming and describing texture modified foods and thickened liquids will reduce the risk of choking among aged care residents, a dysphagia expert tells Australian Ageing Agenda.

The International Dysphagia Diet Standardisation Initiative (IDDSI) has developed standardised terminology in 28 languages for texture modified foods and thickened liquids.

IDDSI aims to improve the safety of more than 500 million people worldwide with swallowing difficulties, known as dysphagia, and reduce risks associated with choking on food and aspirating on liquids.

Behind falls, choking is the next most common cause of preventable deaths in aged care in Australia, according to Monash University research published in the Medical Journal of Australia last year (read our report here).

Julie Cichero

IDDSI co-chair Dr Julie Cichero provided an update on the framework at Speech Pathology Australia’s national conference in Adelaide on Tuesday ahead of its 1 May 2019 implementation across Australian healthcare sectors.

The new framework provides a common language that will reduce the risk of older people choking, Dr Cichero told Australian Ageing Agenda.

“The IDDSI framework has four levels of drink thickness and four levels of texture modified foods informed by systematic review and international stakeholder surveys,” Dr Cichero told AAA ahead of the conference.

The current Australian standards, which are 10 years old, only have standardised terminology for three levels of drink thickness and texture modified food each.

Other key features of IDDSI include a person-focused rather than profession-centred approach and global terminology suitable for all cultures and care settings, said Dr Cichero, a member of Speech Pathology Australia.

“It is accompanied by practical and valid measurement techniques to improve safety in ensuring that what is prescribed is what is received,” she said.

Standardised colours of labels have also been chosen to address the needs of those with red and green colour blindness.

The IDDSI was developed by a group of volunteers worldwide from professions including speech pathology, nutrition and dietetics, medicine, occupational therapy, nursing, patient safety, engineering, and food science and technology.

Dr Cichero said their goal was to provide a common language to reduce choking deaths and other complications from dysphagia that could easily occur when labelling and names varied between care settings, states and countries.

She highlighted that choking was the second highest preventable cause of death in aged care and a 2015 NSW Ombudsman report into the deaths of people with disability in residential care that found confusion over the current terminology may have contributed to choking-related deaths.

“People over the age of 65 years have seven times higher risk of choking on food than children aged one to four years of age,” Dr Cichero said.

“If we are all speaking the same language and we can measure and ensure we have the right drink thickness and the right food texture for the person with swallowing difficulties each time they have a meal, we can reduce this risk.”

The IDDSI standardised terminology was implemented in New Zealand in January this year and, along with Australia, is due to be implemented in the UK and Canada next year.

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3 Responses to Global initiative aims to improve safety for residents with dysphagia

  1. Simon Gould June 5, 2018 at 4:54 pm #

    In recognition that second highest preventable cause of death in aged care (8%) and as quoted “People over the age of 65 years have seven times higher risk of choking on food than children aged one to four years of age,” We have introduced a new anti-choking device (LifeVac) that has already saves 11 lives after first aid has failed. Correct preparation of food, proper supervision and prompt first aid can reduce the risk but these measures sadly do no not always work.The LifeVac device is registered on the NDIS and can be used by carers and the individual themselves for the emergency relief of choking. We believe every aged care facility and disability carer should be equipped with this device.

  2. Jan June 28, 2018 at 6:02 am #

    I have worked in the food industry for many years and have recently become familiar with the IDDSI scale. I think it is good to have standards for facilities that make pureed/minced foods from scratch (that means make them in house by a cook). However, for food manufacturers this is not necessary. Industry have developed their own standards that have been working for many years without issues of people dying. In fact, the food industry has likely saved lives as a result of providing consistent safe food. From what I can gather the scale was not based on any scientific research in a lab. It is based on literature reviews. The IDDSI group did not collaborate with the food industry to come up with the ranges and appear to lack understand of how industry is to translate this scale into mass production. They accepted funding from food manufacturers and then refuse to support them by providing quantitative data that can be used to match the IDDSI scale sighting “lack of resource”. It is also important for people to understand that there is no government body that supports this group and they have not even consulted with any. It is a voluntary program. There is another side to the story on IDDSI.

  3. Dr Julie Cichero July 2, 2018 at 10:17 am #

    Jan, thank you for your comments. The IDDSI framework was developed in consultation with the following groups: people with swallowing difficulties and their carers; health professionals; food service and catering groups; associations that support people with swallowing difficulties; industry; researchers; government organizations. An independent international stakeholder survey was conducted on the draft standards in 2015 with responses from 57 countries. The development of the IDDSI framework followed best practice guideline development such as those endorsed by the NHMRC, SIGN, WHO, NICE and more – please see our peer reviewed publication that is available free here for more details:

    Choking risk was informed by autopsy reports. In many cases food choking is misdiagnosed at the time as a cardiac event. Our most accurate information sadly comes from those who have died. Our aim is to work together with all stakeholders to improve safety for people with swallowing difficulties.

    The IDDSI framework was published in January 2017 (18 months ago) and has the support of many national professional associations in speech-language pathology, dietetics, societies of nutrition management, world congress in healthy aging, international research organizations and many others around the world. Please visit websites of these groups (

    In terms of other external support please this this from the UK NHS supporting the introduction of IDDSI
    And this from Prof Joseph Ibrahim (Health Law & Aging Research Unit, Department of Forensic Medicine, Monday University, Melbourne, Australia) where IDDSI is specifically mentioned in recommendation 20 as part of recommendations for prevention of injury-related deaths in residential aged care services in Australia

    As part of our webinar series, IDDSI would be pleased host a webinar for industry to discuss and address their concerns. We encourage industry to contact us directly to this end (email:

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