What Is an IDDSI Level 6 Diet?
The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global framework with eight levels (0–7) that categorize food textures and drink thickness. An IDDSI Level 6 diet, known as 'Soft and Bite-Sized,' is for individuals who can chew, but may tire easily or have difficulty biting off pieces of food. The key characteristics of Level 6 foods are that they are soft, tender, and moist, with no thin liquid separating from the food. Food pieces must be no larger than 1.5 cm x 1.5 cm (about ½ inch) for adults.
To test if a food item is suitable for a Level 6 diet, use the 'fork pressure test'. When pressed with a fork, the food should easily mash and not return to its original shape. A knife should not be required for cutting.
Protein-Rich Foods
Ensuring adequate protein intake is vital for older adults, and there are many delicious Level 6 compliant options:
- Meat: Tender, slow-cooked meats like casseroles, stews, or roasts are excellent choices. All meat must be finely chopped into 1.5 cm pieces or smaller and served with plenty of thick gravy or sauce to ensure moisture. Shepherds or cottage pie with a meat and vegetable filling is a great option.
- Fish: Flaky, moist fish like cod, haddock, or tinned salmon are suitable, provided all bones and skin are removed. Serve with a sauce to add extra moisture and flavor.
- Eggs: Scrambled, poached, or moist omelets are perfect for a Level 6 diet. They are soft, easy to chew, and packed with protein. Chopped hard-boiled eggs can also be used.
- Beans and Pulses: Well-cooked, skinless beans and lentils, such as baked beans or dahl, are appropriate choices.
- Tofu: Soft tofu, cut into bite-sized pieces, can be a great vegetarian protein source.
Starchy Foods and Grains
Starches are a crucial source of energy, and several can be modified to meet the Level 6 texture requirements:
- Potatoes: Mashed potatoes, soft-boiled potatoes, or well-cooked baked potato flesh (without the skin) are ideal. Adding butter, cheese, or gravy increases moisture.
- Pasta: Very well-cooked soft pasta, such as macaroni or tinned ravioli, can be used, provided it is chopped into small pieces and served with a thick sauce.
- Rice: Well-cooked white rice is acceptable if served in a thick, binding sauce. Avoid dry, sticky, or glutinous rice.
- Cereals: Porridge or instant hot cereals like Ready Brek are excellent. Plain cereals like cornflakes or Weetabix can also be used if soaked thoroughly in milk until soft, with excess fluid drained off.
Fruits and Vegetables
To ensure essential vitamins and fiber, include these modified fruits and vegetables:
- Fruits: Soft, fresh fruits like bananas, ripe peaches, melon, or kiwi are suitable when peeled and chopped into 1.5 cm pieces. Canned fruits in juice (drained) or stewed fruits are also great options.
- Vegetables: Soft-boiled or steamed vegetables like carrots, cauliflower, or courgette should be cut into bite-sized pieces (1.5 cm) and served moist. Mushy peas are also suitable.
Dairy and Desserts
Dairy products and desserts can be nutritious additions to a Level 6 diet:
- Dairy: Thick and creamy yogurt, custard, cottage cheese, and soft cheeses (cut into small pieces) are all safe choices.
- Desserts: Plain sponge cake moistened with custard or cream, milk puddings (like rice pudding or semolina), and egg custards are suitable options.
Food Comparison: IDDSI Level 6 vs. Level 5
It is important to understand the difference between food levels to ensure the elderly person receives the correct diet. Level 6 ('Soft and Bite-Sized') requires some chewing, while Level 5 ('Minced and Moist') is for those who cannot chew at all or have very poor chewing ability.
| Feature | IDDSI Level 6 (Soft & Bite-Sized) | IDDSI Level 5 (Minced & Moist) |
|---|---|---|
| Chewing Required | Moderate chewing is necessary. | No chewing is required. |
| Food Texture | Soft, tender, and moist food pieces. | Finely minced or mashed food. |
| Particle Size | Bite-sized pieces no larger than 1.5cm x 1.5cm. | Food is minced or mashed, with no lumps larger than 4mm. |
| Moisture Level | Moist with no thin liquid dripping from food. | Sufficiently moist, shaped into a ball without liquid separating. |
| Fork Test | Mashes easily with a fork and does not return to its original shape. | Food can be scooped and holds its shape on the spoon. |
Foods to Avoid on a Level 6 Diet
Some foods present a significant choking hazard for individuals requiring a Level 6 diet and should be completely avoided:
- Hard or Dry Foods: Hard biscuits, crackers, crusty bread, dry sponge cake, and tough, crispy, or chewy meat should be avoided.
- Stringy or Fibrous Textures: Foods like pineapple, green beans, or fibrous parts of fruits (e.g., orange zest) are dangerous.
- Skins and Husks: Remove all skins, husks, and seeds from fruits and vegetables, such as apples, grapes, and peas.
- Mixed Consistencies: Avoid foods with a thin liquid and solid food mixed together, like soup with large, unmashed lumps or cereal in milk where the liquid separates.
- Hard Pieces: Nuts, seeds, hard candy, and chewy sweets are choking hazards and must not be consumed.
Conclusion
Transitioning to a Level 6 Soft and Bite-Sized diet is an important step for older adults with chewing or swallowing difficulties. By focusing on tender, moist foods that are carefully prepared and cut into small, consistent pieces, you can ensure their meals are both safe and nutritious. Understanding the difference between food levels and consistently testing food textures are crucial steps in providing safe and enjoyable meals. If you have any concerns about an elderly person's swallowing ability or nutritional intake, it is vital to consult a healthcare professional, such as a Speech and Language Therapist or Dietitian, for a formal assessment.
