Nutrition & Hydration Week 2026 – Swallowing Awareness Day 2026: Supporting Safer Mealtimes in Care Homes

 

 

By Rachel Sipaul, Senior Dietitian at apetito

Swallowing Awareness Day (March 18^th) provides an opportunity for care homes to reflect on their pivotal role in identifying and supporting residents with swallowing difficulties. Dysphagia is not just a clinical diagnosis, it is a core safeguarding issue impacting safety, health outcomes and quality of life for thousands of residents in UK care settings.

Swallowing Difficulties & Consequences

Swallowing difficulties, also known as dysphagia, is widespread among older adults, affecting around 4 million people in the UK, with an estimated 50–75% of care home residents living with the condition ^1,2. Swallowing difficulties develop for many reasons, including dementia, frailty, stroke, Parkinson’s disease, learning disabilities, cancer treatment and simple accelerated muscle loss, all of which can have an effect the complex coordination required to swallow safely ^2,3.

The consequences can be serious ^3-5:

• Aspiration pneumonia, caused by food, drink or saliva entering the lungs
• Choking, sometimes leading to fatal airway obstruction
• Weight loss, falls, pressure ulcers, and delayed wound healing
• Social withdrawal, loss of dignity and distress during meals
• Malnutrition and dehydration, resulting from reduced intake or food avoidance

A downwards malnutrition cycle can happen very quickly. Dysphagia can lead to a reduced dietary intake, which leads to further muscle wasting, including the muscles needed for swallowing, which then worsens the dysphagia ^2,3,5. Recognising this cycle and intervening quickly is essential to minimise the risk of malnutrition. =

Spotting the Warning Signs

Some residents may recognise that they are having a problem with swallowing and can ask for support, others however may not recognise the symptoms. It is therefore important that care home staff can recognise the ‘red flags’ of dysphagia which include ^3,5:

• Coughing or choking during or after meals
• Wet or “gurgly” voice
• Drooling or difficulty managing saliva
• Holding food in the mouth or prolonged chewing
• Fatigue or drowsiness during meals
• Recurrent chest infections
• Unexplained weight loss or reduced intake

Identifying dysphagia is part of everyone’s role, and therefore it is crucial that all care and support staff receive appropriate training in identifying the signs of dysphagia ^1,2.

The importance of training is well demonstrated by East Sussex Healthcare NHS Trust. Before adopting whole team dysphagia training, the trust reported 21 choking related incidents in a year, including several serious adverse events. After training, they reported an 85% reduction with just one incident in 2023 and 0 serious adverse events ¹. This is clear and compelling evidence that training saves lives.

Texture Modified Diets and the IDDSI Framework

Dysphagia is managed by modifying the texture of food and fluids to reduce the risk of aspiration and choking ⁶. Texture modification alters the consistency of food making it easier to chew or eliminating the need for chewing altogether. The level of texture modification will be dependent on the severity of the dysphagia and the resident’s needs.

The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global initiative that has standardised the terminology and definitions used to describe texture modified foods and liquids⁷. The framework uses a continuum of 8 levels, with the following definitions applying to food thickness:

• Level 3 – Liquidised
• Level 4 – Puréed
• Level 5 – Minced & Moist
• Level 6 – Soft & Bite Sized
• Level 7- Easy to Chew

It is essential that texture modification is correct, consistent and tested every time. Meals can be prepared in-house, or pre-made texture modified meals are also available. By using a pre-prepared solution, this can save time and provide peace of mind to both staff and residents, as the meals are compliant with IDDSI guidelines.

To support accuracy, IDDSI offers free, practical tools including guidance notes, posters, training videos and audit checklists, which care homes can implement as part of routine mealtime practice (www.iddsi.org/DSI). It is important that all staff, kitchen teams and care teams share the same understanding, testing methods and communication systems ⁵. For more information a recent podcast explains how care homes can implement the IDDSI framework ⁸.

The Dining Experience

Swallowing safety is not just about food textures. A safe, supportive dining environment and person-centred care routines make a major difference ^1,6. The following can be helpful environment aids:

• Ensuring upright seating and proper posture
• Reducing distractions such as loud TV or rushed mealtimes
• Using contrasting crockery to support residents with visual or cognitive decline
• Serving small, manageable portions
• Giving clear cues: “chew,” “swallow,” “slow down”
• Checking the mouth is clear before the next mouthful

Dysphagia can lead to embarrassment, social withdrawal and reduced appetite. Compassionate support, allowing enough time and creating a calm and inclusive dining room have a measurable impact on intake and wellbeing and enable the resident to ‘Dine with Dignity’ ⁶.

Conclusion

Swallowing Awareness Day invites care homes to reflect on how safe eating and drinking are fundamental to resident wellbeing, dignity and quality of life. By prioritising training, implementing IDDSI consistently, improving dining environments and adopting whole‑team approaches, care homes can dramatically reduce risks and create safer, more supportive mealtime experiences.

When dysphagia is recognised early and managed properly, residents not only remain safer, but they also dine with dignity and have an improved wellbeing.

 

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References

1. Care England. The UK Landscape for Dysphagia Management  Solutions:Enhancing Care and Improving Lives in the UK Health and Social Care Sector 2024.
2. Royal College of Speech and Language Therapists. Guidance on the Management of Dysphagia in Care Homes. 2025.
3. Holdoway A, Smith A. Dysphagia: Malnutrition Pathway Fact Sheet. 2019.
4. Scottish Intercollegiate Guidelines Network. SIGN 119. 2010.
5. British Dietetic Association. Care Home Digest. 2024.
6. Lee Martin. Practical nutrition and hydration for dementia-friendly mealtimes. 2019. ISBN 978 1 84905 700 4.
7. IDDSI. https://www.iddsi.org. Accessed March 2026.
8. Why care homes must get IDDSI compliance right; special podcast with apetito. Care Home Management. https://chmonline.co.uk/why-care-homes-must-get-iddsi-compliance-right-special-podcast/ Jan 2026