Texture modified diets — the challenge: maximising nutrition and consumption

Eating is a fundamental pleasure in life. One of the biggest challenges for foodservices in aged care facilities is creating appealing and tasty meals to bring pleasure for residents requiring texture-modified meals.

Texture-modified diets are designed to make chewing and swallowing safer and easier.

There are four different diet types recognised under the Australian standards, with each being unique and not interchangeable.

1. Regular/unmodified diet: All foods are included here with no restrictions.
2. Soft diet: Foods are slightly different to the regular diet in that tough, chewy, dry foods are excluded. Although not minced, these foods should be 1.5 x 1.5 cm and be moister than most regular textured foods. It is important to note that toast and salads, including raw/shredded vegetables, are not included in a soft diet.
3. Minced and moist diet: Foods should be no larger than 0.5 x 0.5 cm, and contain no hard or sharp pieces.  A blender or vitamiser may be required to achieve this consistency for some foods.
4. Puree diet: Foods should be of a smooth consistency and contain no hard or sharp pieces. Once again, a blender or vitamiser is required to achieve this consistency.

Swallowing difficulties, known as dysphagia, can often occur among the elderly due to a number of conditions such as stroke, head or neck injury, cancer, cerebral palsy, poor dentition, dementia and other illness, or as a result of ageing.

Aspiration (inhaling) of food into the lungs as a result of inadequate chewing or swallowing is recognised as a major contributor to respiratory infections and pneumonia. People with dysphagia often require texture-modified meals to ensure they can continue to consume meals safely without aspirating. A speech pathologist will assess someone with swallowing difficulties to determine which of the four diets will be most suitable to optimise intake and safe swallowing.

The risk of weight loss and malnutrition are often heightened when on a texture-modified diet due to the following factors:

• Early fatigue at meal times.
• Monotony of menu items.
• Diets too low in energy and/or protein.
• Requiring assistance with meals.
• Unappealing meals being served.

A texture-modified diet should reflect the meal offered to residents on regular diets. Food served must be well prepared, flavourful, nutritious and appealing. Variety in flavour is paramount when providing meals to those having texture-modified diets.

Making ‘every mouthful count’ should be the mantra when preparing meals for people with dysphagia to maximise nutrient intake. It is essential to ensure texture-modified meals offer adequate protein and energy. Fortifying meals with extras such as butter, cream, oil, cheese, milk powder or cream cheese can be an excellent way to boost the nutrition of a meal. Some neutral commercial nutritional supplements can also be useful for meal fortification. Talk to your dietitian about different options available.

Lastly, some useful tips to optimise the nutritional intake of people on a texture-modified diet:

• Make meals as visually appealing as possible. Try food moulding, piping to recreate the look of the regular textured meals.
• Ensure good colour and appeal on the plate — try using garnishes.
• Ensure food items are served separately on the plate — don’t mix them all together.
• Add cooking liquids, gravy, milk, butter and sauces to enhance colour and kilojoule (energy) value rather than adding water.
• Vary the type of sauce or gravy that is served with the meal each night to avoid flavour fatigue.
• Use spices to add flavour.
• Consider delightful food smells such as bread baking or coffee brewing prior to meals. These are simple yet effective ways to stimulate appetite and saliva production for people with dysphagia.
• Ensure meals are served at the correct temperature to optimise taste — hot foods hot and cold foods cold.
• Ensure meals offer adequate fibre — blended prunes on cereals/yoghurt, adding legumes/lentils into soups or adding fine textured bran into porridge. Healthy bowels will encourage a healthy appetite.
• Ensure staff and carers are encouraging when serving texture modified meals.

*Samantha Murray is an Accredited Practising Dietitian (APD). She is the Founding Director of Food Solutions Diet Consultants, a specialist team of Aged Care Dietitians and Speech Pathologists consulting throughout Australia. Samantha is a member of the Dietitians Association of Australia’s Food Service Interest Group. To find an Accredited Practising Dietitian (APD), visit the ‘Find an APD’ section of the DAA website at www.daa.asn.au or call 1800 812 942.

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