New aged care food and drink framework coming

Posted by Dr Julie Chicero on 5th September 2018

PEOPLE living in aged care are a vulnerable group with unique food needs.

About 40-60 per cent of people in aged care have trouble with chewing and swallowing to the point where they are at risk of choking on food.

Monash University research shows that choking on food is the second highest cause of preventable death in aged care [1].

Many people, including those living with Dementia, Parkinson’s disease, or survival after Stroke are affected. Food in aged care is often criticised, and while there are improvements that are being sought by many chefs and organisations, the safety requirement for pureed, minced and finely chopped food to address choking risk makes this task difficult.

People over the age of 65 years have 7x the risk of choking on food as children aged 1-4 yrs [2].

Texture modified foods and thick drinks are used to minimise risks associated with choking and the development of life-threatening pneumonia. Standardised names and definitions for different special swallowing diets and drinks improve safety, and Australia has had national descriptions for texture modified food and thick drinks since 2007.

On 1 May 2019 Australia will join many other countries around the world [3,4] in transitioning to a new international standardised terminology for these speciality texture modified foods and drinks – the IDDSI Framework (

The new framework is evidence-based and was developed by an international, multi-professional group following best practice guidelines with input from more than 3,000 stakeholders across 57 different countries [5].  Australia’s adoption of IDDSI, under the guidance of a national steering committee, improves communication throughout the health-chain from community, to hospital to aged care.

For producers of thick drinks and texture modified food, the IDDSI standards mean a single set of labelling for packaging, including standardised colour and number codes, that can be used and recognised around the globe.

The IDDSI framework includes easily accessible testing methods that allow consumers, health professionals and industry to check that the food or drink is correct for someone with swallowing difficulties.

The IDDSI Framework has been endorsed by the Dietitians Association of Australia, Speech Pathology Australia, The Institute of Hospitality in Healthcare, the International Dysphagia Diet Standardisation Initiative and Australian Industry representatives.

Dr Julie Cichero is the Australian Project Officer aiding Australian implementation [6]. With Australia’s aging population projected to more than double by 2057 [7], food and drink for older individuals is an area in need of attention.

ABOUT THE AUTHOR: Dr Julie Cichero is an Honorary Senior Fellow at the University of Queensland’s School of Pharmacy, Faculty of Health and Behavioural Sciences. She is an expert researching, among other things related to swallowing, thickened liquids and texture modified foods. Measurement and standardisation of names and definitions for texture modified foods and thickened liquids used for individuals with dysphagia (feeding and swallowing problems).



[1] The Conversation ‘Many Older people in care die prematurely, and not from natural causes’, May 2017

[2] Kramarow et al. Food related choking deaths among the elderly (2014), Injury Prevention

[3] Australian Aging Agenda

[4]BBC News ‘Patients choked on Hospital soft food’

[5] Cichero et al. Development of international terminology and definitions for texture modified foods and thickened fluids used in dysphagia management: The IDDSI Framework doi: 10.1007/s00455-016-9758-y

[6] Contact Dr Cichero, email:

[7] Australian Institute of Health and Welfare