Texture-modified Food and Dysphagia

Unilever Food Solutions recently attended a panel discussion about texture-modified food for residents with dysphagia, hosted by The Lantern Project. The panellists were Linda Kilworth from My Nutrition Clinic, Speech Pathologist Bernadette Dutton and The Lantern Project’s consultant chef, Loretta Reiken.

Dysphagia reportedly affects up to 60% of residents in Aged Care facilities in Australia, with that number increasing in people who have dementia.

Texture-modified food is a significant factor in helping these people eat healthy, delicious and - importantly - regular meals.

The panel discussion centred around ensuring Chefs were producing meals which helped residents with dysphagia enjoy their mealtimes - as well as what to look out for when it comes to identifying people who might need a texture-modified diet.

Making sure residents are offered food at the right texture level

One of the biggest indicators a resident’s texture level needs to be assessed or reassessed is the amount of food left on the plate when it is returned to the kitchen. Even residents known to have dysphagia, need to be constantly monitored.

There are many factors which can contribute to a change in someone’s eating pattern:

• Previously undetected dysphagia - read more here

• The onset or intensifying of dementia in people with dysphagia

• Dental problems - sore gums, ill-fitting dentures and toothache will all affect one’s ability to chew food.

• Ill health - while someone is unwell, they may require a more textured meal than when they are healthy.
  

Often residents aren’t able to clearly communicate what the issue is which is why it is essential that dining support, kitchen staff and Chefs are always on the lookout for signs a resident requires help with mealtimes.

• Food wastage is one of the most immediate and easiest ways for Chefs and kitchen staff to assess a resident’s need for assessment or reassessment.

• The types of foods not being eaten; for example, softer foods may have been consumed, but food which requires more chewing is left on the plate, can be an indication something has changed with the person.

• Temporary ill-health can make dysphagia worse and require a softer texture level, however when they recover, they are able to enjoy less modified meals again.

Health is not always the reason why a resident with dysphagia is leaving more food on their plate at the end of a meal.
Other possible reasons include:

• The modification process has left the food feeling unfamiliar when they eat it (mouthfeel)

• It may not look appealing or, in the case of the onset of dementia, they no longer recognise the food

• They are temporarily unwell, which can intensify dysphagia symptoms.
  

Clinical and nursing staff can also provide feedback to Chefs if they are supporting residents who are eating in their rooms at mealtimes.

Keeping mealtimes appealing and enjoyable

Texture, taste and smell can all be altered by the texture modification process - and the more modified, the more apparent this becomes.

One of the biggest challenges faced by Aged Care Chefs is ensuring texture-modified meals are visually appealing on the plate. Colour, shape and presentation all play an important part in making sure a meal looks delicious when it is presented. Read our tips here.

Fortification of texture modified foods, while a vital part of keeping residents well-nourished and healthy can affect both the mouthfeel and taste of the food which can confuse people, particularly those with dementia and dysphagia.

Ensuring your dining area smells delicious, is a small but effective way to help those with dysphagia look forward to mealtimes. Knowing they have the mealtime support they need and food which they are comfortable eating are all factors contributing to clean plates and happy residents.

Texture-modified diets in Aged Care are a specialist skill and IDDSI has created the framework for all Aged Care Chefs. It is still relatively new and COVID has hampered its integration into Aged Care facilities. However, Chefs who have implemented IDDSI and are working closely with clinical and nursing staff are better able to observe, assess, and adjust so residents are receiving the right texture level at the right time for their needs.