The Use of Texture Modified Diets in Residential Care Facilities in Auckland

Abstract

Purpose: The use of texture modified diets (TMDs) is a necessity for many of the residential care facility (RCF) residents whether due to swallowing difficulties (dysphagia), poor dentition, physical and/or cognitive impairments. TMDs have been associated with malnutrition. Aims: The aim of the research was to investigate the prevalence of TMD use in RCFs across Auckland, the impact of feeding assistance and food consistency on the amount of food consumed, and the nutritional adequacy and compliancy of the RCF menus and meals. Methods: Ten RCFs (all levels of care) across Auckland were recruited. An on-site meal observation of 459 residents was completed to assess feeding assistance, quantity consumed and dining room environment. Individual weight measurements were collected for carbohydrate, protein and vegetable portions for all meals and were measured according to the Nutrition Standards for Adult Inpatients in NSW Hospitals tool. A TMD check was conducted based on the International Dysphagia Diet Standardisation Initiation (IDDSI) framework. A menu audit using the Dietitians New Zealand Menu Audit Aged Care Facilities tool was conducted. Results: One-third of residents were on TMDs. Residents were more likely to complete their meal when they were on TMDs compared to a regular diet, although, this was not of statistical significance. Feeding assistance was significantly more likely to be provided for residents on TMDs compared to the regular diet (p = 0.0008). There were more healthcare assistants available in smaller RCFs. Protein and carbohydrate serving sizes were most likely to not comply with standards. A greater number of pureed diets met the IDDSI standards while none of the soft and bite-sized diets did. All RCFs provided menus with at least a four-week cycle and three daily meals with additional snacks. TMD meals and snacks were not always displayed in the facility menus. Conclusion: This study provides crucial insights into possible avenues for future research in this field. It highlights the strengths and weaknesses of the current use of TMDs and the mealtime practices in RCFs. Recommendations on further education and training in RCFs will maximise safety and nutrition in this high-risk population group.