The International Dysphagia Diet Standardisation Initiative (IDDSI)
To understand the tests for Level 7 food, one must first be familiar with the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. This globally recognized system provides consistent terminology and testing methods for describing texture-modified foods and thickened liquids for people with dysphagia (swallowing difficulties). The framework consists of eight levels, numbered from 0 to 7, with food textures ranging from Liquidised (Level 3) to Regular (Level 7).
The IDDSI's development was driven by a need to eliminate the confusion and risk associated with previous, inconsistent diet descriptions like “soft” or “chopped,” which varied significantly across healthcare settings. By standardizing terminology and introducing simple, reliable tests using common kitchen tools like forks and spoons, IDDSI has significantly improved patient safety.
The Distinction Between IDDSI Level 7 Regular and Easy to Chew
IDDSI Level 7, represented by the color black, is the highest level on the food scale and includes two main sub-categories: Regular and Easy to Chew. The test required depends entirely on which of these two sub-categories is being prepared. The distinction is critical for patient safety, as the Easy to Chew diet is specifically for individuals who have difficulty with hard or chewy foods but are not at an increased risk of choking.
IDDSI Level 7 Regular
The "Regular" diet is for individuals with no chewing or swallowing problems. For this sub-category, no specific test is required because the person can manage normal, everyday foods of any size and texture. The purpose of this level is simply to classify normal food within the IDDSI framework. It represents the absence of any texture modification needs.
IDDSI Level 7 Regular Easy to Chew
This sub-category is designed for individuals who need softer, more tender foods, often due to weaker chewing muscles, fatigue, or dental issues, but who have no identified choking risk. Unlike the standard Regular diet, this level does have a specific testing method to ensure food safety.
The Test for Level 7 Easy to Chew Food: Fork Pressure and Separation
The test required for Level 7 Regular Easy to Chew food is the Fork/Spoon Separation and Pressure Test. This quick and practical test uses a standard dinner fork or spoon to check the tenderness and softness of a food item.
Here is a step-by-step guide to performing the test:
- Gather tools: You will need a standard metal dinner fork or spoon and a plate.
- Prepare sample: Take a sample of the food, ideally a 15mm cube for consistent testing.
- Perform separation test: Use the side of the fork or spoon to cut or break the food apart. It should separate easily with minimal effort. The texture may flake into smaller pieces.
- Perform pressure test: Place the fork flat on the food sample. Apply enough pressure with the back of the fork to make your thumbnail blanch (turn white).
- Evaluate results: When you lift the fork, the food should be completely squashed and must not regain its original shape. If it does, it is too firm. The food should feel moist throughout.
The Importance of the Easy to Chew Test
While Level 7 Easy to Chew does not have particle size restrictions, the softness of the food is critical. Individuals on this diet need assurance that they will not encounter hard, tough, or chewy textures that could cause discomfort or fatigue during eating. This simple test provides a measurable, objective standard to ensure consistent food preparation, especially in institutional settings like hospitals or aged care facilities. Food characteristics to avoid for Easy to Chew include hard foods (nuts, raw vegetables), tough/chewy foods (steak, candies), crispy foods (crackling, crisp bacon), or stringy foods (pineapple, beans).
Comparison of Level 7 Diets
| Characteristic | Level 7 Regular | Level 7 Regular Easy to Chew |
|---|---|---|
| Chewing Ability | Normal, strong chewing ability. | Adequate chewing ability for soft/tender foods. |
| Swallowing Function | No swallowing problems. | No identified choking risk. |
| Food Texture | All normal, everyday food textures are allowed. | Requires soft and tender textures. |
| Particle Size | No restrictions on food piece size. | No restriction on particle size. |
| Testing Method | No specific test required. | Requires the Fork/Spoon Separation and Pressure Test. |
Conclusion
In summary, the question of what test is required for level 7 regular food has a dual answer depending on the specific dietary needs. For a standard IDDSI Level 7 Regular diet, no test is needed, as it is intended for individuals with no swallowing issues who can consume all everyday foods. However, for the Level 7 Regular Easy to Chew sub-category, a simple yet effective Fork/Spoon Separation and Pressure Test is mandatory. This distinction highlights the IDDSI framework's commitment to personalized care and safety, using common tools to make food preparation reliable and consistent across different environments. A clear understanding of these testing methods is crucial for healthcare professionals and caregivers to ensure individuals with dysphagia-related issues receive appropriate and safe food textures. For more detailed information, consult the official IDDSI website.
Common Foods and Testing for Level 7 Easy to Chew
To ensure food meets the criteria for Level 7 Easy to Chew, it should be naturally soft or cooked until tender. Using the Fork/Spoon Pressure Test, you can check items like:
- Soft meats and fish: Cooked tender meat, fish cooked to flake easily. Press a piece with a fork; it should squash easily.
- Tender vegetables: Boiled or steamed vegetables like carrots or potatoes should be soft enough to be cut with the side of a fork.
- Soft fruits: Ripe banana, peeled peaches, or mango can be easily separated with a fork.
- Soft sandwiches: Sandwiches with soft fillings like egg or tuna salad are acceptable.
Always re-test food at serving temperature, as consistency can change.
Summary of IDDSI Levels
IDDSI provides a comprehensive continuum of levels for both food and drinks, each with specific testing methods. The goal is to provide safe and appropriate textures for individuals with dysphagia, a condition affecting millions globally.
- Levels 0-4 (Drinks): The IDDSI Flow Test, using a 10ml syringe, is used to classify drinks based on their flow rate.
- Level 3 (Liquidised Food): Requires the IDDSI Flow Test and Fork Drip Test.
- Level 4 (Pureed Food): Requires the Fork Drip Test and Spoon Tilt Test.
- Level 5 (Minced and Moist Food): Requires the Fork Pressure Test, ensuring food pieces are 4mm or smaller for adults.
- Level 6 (Soft and Bite-Sized Food): Requires the Fork Pressure Test, checking for softness and ensuring pieces are no larger than 1.5cm.
- Level 7 (Regular Food): As detailed above, the test required depends on the sub-category.
