Brain damage can seriously hamper a person’s ability to swallow food, to the detriment of health and quality of life. Professor Karen MK Chan in the Faculty of Education has been working with nursing homes, caregivers, industry and NGOs to devise solutions. Safe to Swallow About 80,000 people in Hong Kong live in nursing homes and 60 per cent of them suffer varying degrees of swallowing difficulties. That means if food is not prepared to the appropriate texture and size, they risk choking. Often, nursing homes compromise with a puree of meat, rice and vegetables that forms an unappetising greenish brown gloop. Needless to say, it can be a struggle to get residents to eat enough of this to meet their nutritional needs. The problem has been on the radar of Professor Karen MK Chan, Director of HKU’s Swallowing Research Laboratory, who for years has conducted studies on dysphagia (swallowing difficulties) in Hong Kong. She has also developed a book, website and YouTube channel to guide people, and organised training programmes. “Mealtimes are especially challenging in nursing homes in terms of the manpower needed and the kind of food they can offer. We’ve been working with different parties over the years to train up their awareness and develop different kinds of care food products that are of the correct texture for patients,” she said. Some patients may be able to eat roughly chopped food, some finely chopped and some only puree. It depends on their degree of swallowing difficulty, which can arise when muscle control is affected by brain damage, for instance from dementia or stroke, or changes to the swallowing muscles from such things as cancer and cancer treatment. The International Dysphagia Diet Standardisation Initiative (IDDSI) has produced guidelines on nine levels of food consistency, which Professor Chan and her team translated into traditional Chinese (they were adopted by the Hong Kong Council of Social Service in 2023). More recently, she has focussed on their implementation in the community, through two major funded projects targeted at private residential care homes and food providers. funded by the HKEX Foundation. It builds on her earlier work advising companies and NGOs on how to properly prepare care food. Over 18 months, Professor Chan and her team are testing whether the chain’s care food products adhere to the different IDDSI levels (for instance, level five foods must be minced finely enough that food particles are smaller than the gap between prongs on a fork and level three liquids must drip slowly through fork prongs, leaving a residue). They are also working with the chain to make the food more appealing by building on Fairwood’s experience in catering to Hong Kong tastes and shaping the puree into the things that they consist of, such as broccoli and pork. “The problem with the puree provided in most nursing homes is that it is not the most delicious food on Earth and not very welcome by the residents. It takes a lot of effort to convince them to eat it and, for those who need feeding assistance, a lot of effort to make sure they complete the assigned portion for every meal. “We hope the new version of the pureed food will look more attractive and have that Hong Kong taste of the foods we grew up with, like baked pork chop in tomato sauce and chicken curry.” The products are also being tested in several elderly homes, where residents are being assessed on whether the foods affect swallowing safety and support their health, such as by helping them gain weight. Professor Chan noted quality control was becoming more important as care foods became more available in Hong Kong. Several NGOs have developed care foods, HKTV Mall offers a selection for delivery, and care foods are also offered in the restaurants of chains such as Fairwood, Maxim’s and Café de Coral. She is therefore working with the Hong Kong Council for Social Service to develop a system, such as certification, to recognise foods that are of their stated consistency. In any case, the presence of more options is good news for patients and also for Hong Kong. “The government has been emphasising the silver economy. The care food market is a top example of what that means,” she said. Quality control needed The care home project involves 220 homes – about a quarter of the total in Hong Kong – where Professor Chan and her team are training kitchen staff to produce care food according to the IDDSI guidelines, as well as training staff and volunteers to assist residents in strengthening their swallowing muscles through specially designed games on iPads. The programme runs over three years and is funded by the Hong Kong Jockey Club Charities Trust. “We are taking away the need to rely on a speech therapist to be there to do the exercises,” she said. The food project involves the Fairwood fast food chain and is Diet and exercise With support from Professor Chan’s team in product development and testing, Fairwood became the first fast food chain in Hong Kong to offer soft meals. HKU Bulletin | Nov 2025 Knowledge Exchange 38 39 We hope the new version of the pureed food will look more attractive and have that Hong Kong taste of the foods we grew up with. Professor Karen MK Chan
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