Dysphagia following stroke and its impact on eating and drinking
Eating and drinking should be a pleasurable experience for everyone, even if you have dysphagia.
Good nutrition and hydration is essential throughout our lives. It is particularly important after a serious health event such as stroke, when the body needs to work extra hard to recover. However, for over half of stroke patients1, swallowing difficulties (also known as dysphagia) can make mealtimes a time of fear and anxiety. Normal food and drinks become hard to swallow, and choking or accidentally inhaling food into the lungs (‘aspiration’) becomes a real possibility2. This makes hitting nutritional targets difficult, and malnutrition and dehydration more likely3-8, which in turn can create additional clinical problems and hinder recovery.
What is a dysphagia diet?
After being diagnosed with dysphagia after stroke, patients may be recommended to consume specially tailored dysphagia food, known as a ‘texture-modified diet’. This is because people with dysphagia usually find it safer and easier to swallow food and drink with an adapted consistency and smooth texture. A speech and Language Therapist (SLT) or other healthcare professional will determine the severity of dysphagia and the required texture modification. They may also recommend the use of a special thickening agent that will help the person preparing the dish to get exactly the right consistency each time.
Mealtimes: more than just nutrition
When thinking of mealtime priorities for people with dysphagia, being able to swallow food and drinks safely is number one. Second to that is ensuring they get enough of the right nutrition, which plays an important role in their survival, recovery and wellbeing. However, whilst safety and nutritional value are both essential, getting pleasure from mealtimes with family or friends is also important for a person’s overall quality of life. Ideally, mealtimes should be positive, relaxed and enjoyable occasions. Therefore, making meals and drinks are pleasurable because they look appetizing and taste delicious should also be a priority. Having the right cooking equipment and utensils is a great start – you may have most of these in your kitchen already.
Cooking dysphagia foods
- People with dysphagia often find it hard to eat and drink enough food and liquid, which can lead to weight loss, dehydration and malnutrition3-8. To help prevent this, high-calorie ingredients such as full-fat milk, butter, sugar or cream in your cooking, may be appropriate.
- Carefully consider the best cooking methods to achieve the necessary texture. For example, poaching or simmering will soften ingredients, making them easier to purée.
- You can add flavor by browning and roasting ingredients prior to poaching and simmering.
- Plan meals so that you have a range of colors on the plate, making them more appealing to the eye.
- Chilled foods may be easier to swallow.
Puréed dysphagia food: Tips
- Use a powerful liquidizer and/or food processor to produce smooth consistencies.
- Often, blenders don’t work well with small quantities of food. If you purée more than you need, portion the remainder and freeze, or use as a base for a soup.
- Hot food breaks down more easily than cold food. So where possible, purée when it is still hot (but not boiling). Check your blender is suitable for hot food first.
- Leave your food processer running for longer – the purée will become smoother and thicker the longer it is blended.
- We eat with our eyes, as well as our mouths. Making food that smells good and looks appealing can help to boost appetite.
- Use molds to make food look better and more recognizable. They can also reduce preparation time and wastage.
- Piping bags can help you make interesting shapes and designs on the plate.
- Unless preparing a complete dish, make sure that individual components of a meal are separated on the plate.
- Make an interesting shape on the plate with a ‘quenelle’, in which the purée is formed into an oval shape between two spoons
- Use different shaped and colored plates for each dish.
Improving swallow safety
- Preparing food for someone with swallowing problems can feel daunting, but it becomes easier with practice. The main challenge is making food and drinks the right thickness and texture for safer swallowing, but there are other steps you can take to improve safety of swallowing for people with dysphagia:
- Don’t rush mealtimes– eating too quickly is the main cause of coughing and choking
- Give regular verbal prompts such as “take your time”, “put your fork/spoon down between mouthfuls” and “remember to chew”
- Use a smaller spoon or fork to reduce the amount of food in each mouthful
- Only half-fill cups and glasses with liquid, to discourage drinking too much at once
- Transfer food from a serving plate onto an eating plate so only small amounts are served at a time – this helps slow down the meal and provide time for pauses and conversation
To further improve safety, there are certain foods that dysphagia patients have trouble swallowing so should be avoided. These include thin or watery liquid foods, like tea, soup, or juice, sticky foods, dry foods, like bread, potatoes, or cake, as well as nuts and seeds.
Download 'Swallowing difficulties after stroke'
This guide has been developed for (carers of) patients who have suffered a stroke and is having problems with swallowing. The guide amongh others prepares for a return home, including tips to make mealtimes more enjoyable, and explains why swallowing difficulties should not be ignored.
Try the minced beef or Bolognese sauce recipe
Preparing food for someone with dysphagia becomes easier with practice. Try this quick and simple minced beef or Bolognese sauce recipe to help learn the basic skills when cooking for someone with dysphagia.
- Martino R, et al. Stroke, 2005;36:2756–63.
- Marik PE, et al. Chest, 2003; 124: 328–36
- Finestone HM, et al. Arch Phys Med Rehabil, 1995;76: 310–6.
- Hama S, et al. Metabolism, 2005; 54:699–704.
- Yoo SH, et al. Arch Neurol, 2008; 65:39–43.
- Mann G, et al. Stroke, 1999;30:744–8.
- Daniels SK, et al. Arch Phys Med Rehabil, 1998;79:14–9.
- Kidd D, et al. QJM, 1995; 88:409–13.
- González-Fernández M, et al. Curr Phys Med Rehabil Rep, 2013;1(3):187-96.
- Martino R, et al. Dysphagia, 2000;15:19–30.
- Martino R, et al. Stroke, 2005;36:2756–63.
- Marik PE, et al. Chest, 2003; 124: 328–36.