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One of the key things to understand with the ageing process and dysphagia is that while dysphagia is the deterioration of the swallowing action, it often deteriorates at the same time as a person’s ability to chew the food properly in the first place.  

As an illustration of what happens, this video about minced and moist sandwiches shows what happens when a person isn’t able to chew their food properly and even a simple sandwich can pose a choking hazard.

For people who are experiencing difficulty chewing food, a Level 5 diet is often recommended or prescribed by a speech therapist or dietitian.

Level 5 is minced and moist food, and is defined by three criteria under the IDDSI:

  • Texture 
  • Softness 
  • Moisture
Texture

Description

The texture of food is to be particle sizes of 2 to 4 mm in size. Some textural variety is acceptable. For example, a grain of rice is typically 3 mm x 10 mm and can still be easily swallowed. 

Test

The food must easily be eaten with a fork or chopsticks.

 

 

Method

A regular 4-pronged dining fork will consistently mash food to this particle size. 

 

Example

Level 5 rice.

01:06

    

Softness

Description

The food should be soft enough that it can be further broken down by using the tongue or a gentle chewing action. 

Test

The food can still be easily picked up using a standard fork or chopsticks, it does not drip off or run through the eating implements.

 

 

Method

Using a fork to press down on the food: the fork prongs should mash the food at a pressure which does not turn the thumbnail white when pressing down. A light pressure should suffice. 

Example

Level 5 rice.

01:06

    

Moisture

Description

The correct moisture is important for both enjoyment as well as to aid in the ease of swallowing. 

Test

Use the spoon tilt test.

 

 

Method

Adding moisture-based foods to the meal such as sauces, milk, yoghurt and custard all increases the moisture profile of a dish. 

Example

Level 5 smashed potato.

00:58

 

FAQ

When should I test the texture level of the food I am preparing?

The texture level test needs to occur when the food is at the temperature it will be consumed. If you test it when you bring it out of refrigeration, it may be too solid, or if it is piping hot, it may be too liquid for the level required.

How often should I test the texture level of a meal? 

You shouldn’t have to test every single meal. If there is no change to the way the food is prepared, or the ingredients are used, or the temperature it is being served at, then the texture level should remain consistent. 

If any of the conditions change, for example, a new product is being used, the food is served chilled in summer and warm in winter, then the levels must be retested. 

It is also important to make sure everyone in the kitchen who will prepare the meal have received consistent instructions on how to achieve the right texture level for each specific meal on the menu. Consistent and hands-on training is the key to making sure everyone clearly understands the levels, the tests and the risks.  

How often should I test the texture level of a meal? 

You shouldn’t have to test every single meal. If there is no change to the way the food is prepared, or the ingredients are used, or the temperature it is being served at, then the texture level should remain consistent. 

If any of the conditions change, for example, a new product is being used, the food is served chilled in summer and warm in winter, then the levels must be retested. 

It is also important to make sure everyone in the kitchen who will prepare the meal have received consistent instructions on how to achieve the right texture level for each specific meal on the menu. Consistent and hands-on training is the key to making sure everyone clearly understands the levels, the tests and the risks. 

Additional information - Audit Sheets