The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a globally recognized framework for describing and managing texture-modified diets and thickened fluids. IDDSI Level 5, known as 'Minced & Moist,' is designed for individuals who have some chewing ability but struggle with biting off pieces of food safely. To accurately confirm that a food item meets this standard, a two-pronged testing approach is required: the Fork Pressure Test and the Spoon Tilt Test.
The Fork Pressure Test
The Fork Pressure Test is a key method to assess if food is soft enough and has the appropriate particle size for Level 5. This test helps ensure the food can be easily broken down.
How to perform the Fork Pressure Test:
- Place a small food sample on a flat surface.
- Gently press with a metal fork until your thumbnail blanches white.
- Observe how the food responds.
Passing the Fork Pressure Test
Food passes if it squashes and separates easily, passing through the fork tines. The particles for adults should be about 4mm, comparable to the space between fork tines. The food should stay flattened after pressure is released.
The Spoon Tilt Test
The Spoon Tilt Test assesses the food's cohesiveness and how well it holds together. This prevents food from breaking apart or being too sticky.
How to perform the Spoon Tilt Test:
- Scoop food onto a spoon.
- Observe if it holds a cohesive shape.
- Gently tilt and lightly flick the spoon.
Passing the Spoon Tilt Test
Food passes if it holds its shape on the spoon but slides off easily when tilted or flicked. Only a thin film should remain on the spoon, indicating it's not overly sticky.
Why a Combination of Tests is Required
Both tests are necessary because they evaluate different, essential aspects of Level 5 food. The Fork Pressure Test confirms softness and particle size, while the Spoon Tilt Test checks for the right level of cohesiveness. Using both ensures the food is safe in both texture and consistency for individuals with dysphagia.
Comparison of IDDSI Level 5 Testing Methods
| Feature | Fork Pressure Test | Spoon Tilt Test |
|---|---|---|
| Purpose | Assess tenderness and particle size. | Assess cohesiveness and stickiness. |
| Action | Press down gently with fork tines. | Scoop and tilt/flick the spoon. |
| Main Pass Criteria | Food mashes easily and passes through fork tines. | Food holds shape and slides off easily. |
| Critical Assessment | Softness and moisture content. | Cohesiveness and absence of stickiness. |
| Potential Failures | Food is too hard, tough, or fails to mash easily. | Food is too sticky, too dry, or falls apart. |
Modifying Foods for Level 5 Compliance
If food fails a test, it needs modification. This might involve adding thick sauces or gravies to increase moisture (without creating separate thin liquid) or using a food processor to achieve the correct particle size (no larger than 4mm for adults). Avoid incompatible items like nuts, dry cakes, or stringy vegetables. More detailed guidance is available on the IDDSI website.
Conclusion
To definitively check that food is level 5 minced and moist, utilizing both the Fork Pressure Test and the Spoon Tilt Test is the most suitable method. These objective tests using standard kitchen tools ensure the food has the correct softness, particle size, and cohesiveness for safe consumption by individuals with dysphagia. Consistent testing of food batches, considering temperature and reheating effects, is vital for maintaining dietary safety.
