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Surprisingly, bread and toast require the same number of 鈥榗hews鈥� as raw apple, nuts and steak. Those who aren鈥檛 able to chew toast sufficiently are at a high risk of choking.

Bernadette Dutton, principal speech pathologist at , surveyed health professionals at a Primary Health Network (PHN) Aged Care Forum and alarmingly,聽40% of those surveyed incorrectly believed that toast was suitable for those on a 鈥榮oft鈥� food texture diet¹.

The flow-on implications for residents living in residential aged-care facilities are potentially dangerous. When we acknowledge that choking is the second highest cause of preventable death in residents living in aged-care facilities², the survey results present an alarming figure.

Why do bread and toast have a high choking risk? 鈥淔rom a food texture point of view, bread and toast are fibrous, generally dry with a low moisture content and importantly, can鈥檛 be cut with the edge of a fork, which is what is required for a 鈥榮oft鈥� food texture diet,鈥� said Dutton. 鈥淓ating toast requires good oral strength and control to chew and swallow. Without this, a person is at increased risk of choking. In addition to assessing communication ability, a speech pathologist is trained in assessing a person鈥檚 swallow ability and whether someone is at increased risk of choking,鈥� she said.

Of course, there are exceptions to every rule. Following an individualised swallowing聽assessment, a聽speech pathologist may include toast in his or her recommendations, though they still need to be assessed by the speech pathologist to ensure safety. Adequate teeth and/or well-fitted dentures are also required to chew bread and toast safely.

Aged-care facilities that do not follow are putting residents at risk if they provide toast to residents with a prescribed modified texture diet (including soft, minced and moist or smooth puree) without prior speech pathologist approval.

Death as a result of choking is preventable. Choking risk is reduced when residents are correctly assessed, prescribed and provided with their optimal diet, and staff and family are educated on swallowing disorders and safe swallowing strategies. Informed consent, clear communication regarding recommendations, thorough documentation, consideration of residents鈥� informed choice and quality of life are all paramount when speech pathologists are managing residents in aged-care facilities.

1. Brisbane North Primary Health Aged Care Forum, 24 September 2015. 67 respondents.

2. Ibrahim et al (2015), Nature and Extent of External-Cause Deaths of Nursing Home Residents in Victoria, Australia. Journal of the American Geriatrics Society.