Feature Article
Dysphagia: Belgian dietitians learn how to implement International Dysphagia Diet Standardization Initiative (IDDSI)
  • Dysphagia is a major health concern among older adults living in healthcare institutions in Belgium. Many nursing homes are willing to adopt IDDSI terminology in order to improve their quality of care.

    Belgium has a population of over 11 million people. More than 2 million people are aged 65 or above and this number is rising from year to year. An ageing population results in an increase in the number of beds in senior care institutions that is close to 140.000, according to national healthcare statistics1.

    Of course, ageing patients are not the only ones suffering from dysphagia, but they make up the majority of them. The prevalence of dysphagia in Belgium is not easy to assess. We know it is frequently found in patients suffering from more than one condition and in those staying in nursing homes. Although we may lack recent statistics, available studies report that up to 68 percent of patients in healthcare institutions have been diagnosed with dysphagia, and the same is true for 10 to 16 percent of patients who live at home2

    Need for a common terminology

    The healthcare system in Belgium is well organized, but when it comes to patients with feeding, choking or swallowing problems, things may get a little complicated. Hospitals and long-term care homes of the country are currently serving dysphagic patients’ meals and drinks of adapted texture, but each healthcare institution has its own criteria and denomination of textured food and thickened liquids. The differences in the terms of dysphagia diets can result in great confusion. The patient can even experience bad consequences of inadequate food and drink texture, such as dehydration, undernutrition or respiratory tract infection. When you know that in senior nursing homes, it is frequent that one patient out of every two is suffering from dysphagia, you realize how important it is, to handle this problem carefully. In addition, there are 3 official national languages in Belgium (Dutch, French and German) and that further complicates the communication between healthcare institutions. This is why International Dysphagia Diet Standardization Initiative (IDDSI) appears to be particularly useful in the country.
    IDDSI training for dietitians
    In November 2018, the Belgian French-speaking national dietetic association organized a one-day training on meals of modified texture and IDDSI implementation for its members. There were 62 participants: dietitians, speech therapists and chefs. The participants worked mainly in small to medium size nursing homes (from 100 to 400 bed units). Smaller healthcare institutions have limited financial resources and are not able to buy high-tech kitchen equipment. The IDDSI training focused on that specific limitation and was about implementing IDDSI with standard equipment. On the day of the training, the morning time was dedicated to oral presentations by a dietitian, a speech therapist and a catering director. For lunch, participants were served a traditional Belgian dish, “Flemish stew”, which consists of beef pieces and chopped carrots stewed for a long time with beer and veal stock, served in a delicious brown sauce. The recipe had been formulated for different IDDSI stages so that participants could experience the different textures. The afternoon session of the training was spent on practical cooking demonstrations. 
    With this training, the Belgian French-speaking national dietetic association intended to spread the knowledge of IDDSI terminology and thereby to contribute to the IDDSI implementation in the country as well as to foster collaboration between healthcare professionals involved in the care of patients with dysphagia.
    Magali Jacobs (Belgium)
    Dietitian, member of UPDLF (Union Professionnelle des Diététiciens de Langue Française : Belgian French-speaking national dietetic association)
    References : 
    1. Institut National d’Assurance Maladie-Invalidité (2016). Statistiques et évolution du secteur des maisons de repos. Retrieved from https://www.inami.fgov.be/fr/professionnels/etablissements-services/maisons-repos/Pages/statistiques-evolution-secteur-maisons-repos.aspx
    2. Alleparts, S., Delcourt, S., & Petermans, J. (2008). Les troubles de la déglutition du sujet âgé : un problème trop souvent sous-estimé. Revue Médicale de Liège, 63(12) : 715-21.