What Is the EAT-10? (Eating Assessment Tool-10)
The EAT-10 (Eating Assessment Tool-10) is a validated, self-administered swallowing screening questionnaire developed by Belafsky et al. (2008). It consists of 10 simple questions that a patient or caregiver completes to identify potential dysphagia (swallowing difficulty) before a formal clinical assessment.
EAT-10 is widely used across Hong Kong hospitals, elderly care homes (安老院), and rehabilitation centres as a rapid first-line screen. It takes under 3 minutes to complete and requires no specialist equipment.
Why EAT-10 Matters in Hong Kong
Hong Kong’s rapidly ageing population faces a significant dysphagia burden:
- ~600,000 residents are estimated to have some degree of swallowing difficulty
- 30–40% of care home residents require dietary modification
- Stroke, Parkinson’s disease, and dementia are the leading causes — all rising in prevalence
Early identification through screening tools like EAT-10 allows timely referral to a speech therapist (言語治療師), reducing the risk of aspiration pneumonia, malnutrition, and hospitalisation.
The 10 EAT-10 Questions
Each question is scored from 0 (no problem) to 4 (severe problem). The patient or caregiver rates each statement honestly.
| # | Question | Score (0–4) |
|---|---|---|
| 1 | My swallowing problem has caused me to lose weight | 0 → 4 |
| 2 | My swallowing problem interferes with my ability to go out for meals | 0 → 4 |
| 3 | Swallowing liquids takes extra effort | 0 → 4 |
| 4 | Swallowing solids takes extra effort | 0 → 4 |
| 5 | Swallowing pills takes extra effort | 0 → 4 |
| 6 | Swallowing is painful | 0 → 4 |
| 7 | The pleasure of eating is affected by my swallowing | 0 → 4 |
| 8 | When I swallow food sticks in my throat | 0 → 4 |
| 9 | I cough when I eat | 0 → 4 |
| 10 | Swallowing is stressful | 0 → 4 |
Total score = sum of all 10 responses (maximum 40).
EAT-10 Scoring Guide
| Total Score | Interpretation | Recommended Action |
|---|---|---|
| 0–2 | Normal range — unlikely dysphagia | Continue monitoring; reassess if symptoms change |
| 3–14 | Possible dysphagia — at risk | Refer to speech therapist for formal assessment |
| 15–28 | Moderate concern | Priority referral; consider dietary texture adjustment |
| 29–40 | Severe concern | Urgent referral; consider nil-by-mouth until assessed |
A score of 3 or higher is the clinical threshold for referral in most Hong Kong hospitals and the Hospital Authority guidelines. EAT-10 alone does not diagnose dysphagia — it flags patients who need a formal swallowing evaluation (clinical swallowing examination or videofluoroscopy).
How EAT-10 Is Used in Hong Kong Care Homes and Hospitals
In practice across Hong Kong:
Hospitals (醫院)
- The Hospital Authority (HA) uses EAT-10 or equivalent screens at admission for stroke, elderly, and neurological patients
- Speech therapy departments at Queen Mary Hospital, Prince of Wales Hospital, and regional hospitals incorporate EAT-10 in their triage workflows
- Scores ≥3 trigger a speech therapist consultation request
Elderly Care Homes (安老院)
- The Social Welfare Department (社會福利署) recommends periodic swallowing assessment for residents with known risk conditions
- Registered nurses and care staff are increasingly trained to administer EAT-10 as a frontline screen
- Many homes re-screen quarterly or after any significant medical event (e.g., stroke, pneumonia, weight loss)
Rehabilitation Centres
- Post-stroke and post-surgical rehabilitation programmes use EAT-10 to track recovery over serial assessments
- A falling score (improving) indicates successful swallowing rehabilitation
EAT-10 vs. Other Screening Tools
| Tool | Questions | Time | Validated in Chinese? | Best For |
|---|---|---|---|---|
| EAT-10 | 10 | ~2 min | Yes (Traditional & Simplified) | All adults; self/proxy report |
| GUSS | 4 stages | ~5–10 min | Partial | Acute stroke patients |
| 3-oz Water Test | 1 trial | ~2 min | N/A | Rapid bedside screen only |
| MASA | 24 items | ~15 min | No | Detailed clinical assessment |
EAT-10 is preferred in community and care home settings because it can be completed by the patient or a family caregiver without clinical presence, making it practical for Hong Kong’s high-volume residential care context.
Warning Signs That Should Prompt Immediate EAT-10 Screening
Even without a formal referral, conduct an EAT-10 screen if you observe:
- Coughing or choking during or after meals
- Wet or gurgling voice after eating or drinking
- Food or liquid coming out of the nose
- Unexplained weight loss of >2 kg over 1 month
- Recurrent chest infections or aspiration pneumonia
- Reluctance to eat or meals taking significantly longer than before
- Drooling or food residue in the mouth after swallowing
These are common early signs of dysphagia in Hong Kong elderly and neurological populations.
Clinical References
- Belafsky PC, et al. (2008). Validity and Reliability of the Eating Assessment Tool (EAT-10). Annals of Otology, Rhinology & Laryngology, 117(12), 919–924.
- Burgos R, et al. (2012). Screening for dysphagia with EAT-10 in hospitalised patients. Clinical Nutrition, 31(6), 816–821.
- Hospital Authority Hong Kong. Clinical guidelines for the management of dysphagia in adults (internal guidance, updated periodically).
- Hong Kong Speech Therapy Association (HKSTA). Professional guidelines for swallowing assessment in the elderly.
Free EAT-10 Screening in Hong Kong
Try EAT-10 online free: SeniorDeli’s free EAT-10 screening tool is used by speech therapists across Hong Kong. Download the free app to track scores over time, store results for multiple family members, and share reports directly with your speech therapist.
The SeniorDeli app includes:
- Built-in EAT-10 questionnaire (English and Traditional Chinese)
- Score history and trend graph across visits
- One-tap PDF export for clinical handover
- IDDSI meal classification guide linked to each score level