UNASSIGNED: The International Dysphagia Diet Standardization Initiative (IDDSI) has created global standardized definitions for texture-modified diets (TMDs) and thickened liquids to improve the safety and care for individuals with swallowing difficulties. The IDDSI framework guides health care facilities, such as aged care, to provide food to at-risk patients.
UNASSIGNED: This study aims to design, deliver, and evaluate a tailored intervention to facilitate IDDSI implementation in aged care.
UNASSIGNED: Five aged care facilities received tailored interventions, which were guided by the Expert Recommendation for Implementing Change process and used the corresponding barriers identified in the previous study: 1) tailored material, delivery, and planning; 2) opinion leaders and professional input; 3) strategies to attract and involve staff; and 4) reflections and evaluations. Meal compliance against IDDSI standards and staff knowledge acquisition were the primary outcomes evaluating the impact of the intervention. Written consent was obtained from facility managers. Staff trainings were delivered by a dietitian, accompanied with electronic and printed materials. An audit was conducted on all items listed on the TMD daily menu (lunch, dinner, and midmeals). TMD IDDSI audits and staff self-administered surveys were conducted before and 6 mo after the intervention.
UNASSIGNED: Audits of 68 and 79 TMD meals/items were conducted pre- and postintervention, respectively. Significant improvement in meal compliance was found in all 3 levels of TMDs, including soft and bite-sized (50%; P = 0.0001), minced and moist (44%; P = 0.0024), and puréed (42%; P = 0.0024). The overall IDDSI compliance increased by 46% postintervention (P < 0.0001). Staff achieved higher scores in both dysphagia and IDDSI knowledge sections (P < 0.0001).
UNASSIGNED: Tailored interventions facilitated IDDSI implementation in aged care evidenced by increased TMD compliance and staff knowledge, which remained at 6 mo postintervention.

This study aimed to evaluate an existing liquid-thickening guideline provided by a major manufacturer of thickener in Hong Kong and to provide directions for the implementation of the IDDSI framework. Fifteen participants who are naïve to liquid thickening were required to prepare thickened liquids samples from three drink bases (i.e., Milk-tea, Chinese tea, and Herbal tea) at two target consistency levels (i.e., mildly and medium/moderately thick) based on two guidelines (i.e., the manufacturer\'s guideline and an IDDSI-driven guideline). Viscosities of the samples were measured rheologically to reflect liquid consistency. The manufacturer\'s guideline resulted in distinguishable viscosities at the two consistency levels (F(1, 35.464) = 113.764, p < 0.001, ηp2 = 0.802), as well as different viscosities in different drink bases (F(1.267, 35.464 = 92.951, p < 0.001, ηp2 = 0.769). Comparison between the manufacturer\'s and the IDDSI-driven guideline showed that the later resulted in more viscous liquid samples in all drink bases and at both consistency levels. The difference between the two guidelines was statistically significant (F(1,28) = 35.137, p < 0.001, ηp2 = 0.557). Following only the manufacturer\'s guideline when thickening non-water beverages may lead to discrepancy between the resultant and prescribed consistencies. Thus, it should be considered inadequate to ensure swallowing safety. The effect of drink base should be emphasized to patients and caregivers, and pre-serving tests should be introduced. Despite similar classifications and terminologies used between the current local framework and the IDDSI framework, measures should be taken to avoid potential confusions and associated threats to swallowing safety.