Current Practices and Opportunities for Texture-Modified Diets in Aged Care Facilities

Abstract

Aims: An increased ageing population is driving demand for aged care services. Swallowing difficulties (dysphagia) and malnutrition are prevalent in aged care facilities (ACFs). To ease the chewing and swallowing process and improve patient safety, texture-modified diets (TMDs) are commonly prescribed for older adults with dysphagia. This thesis aimed to evaluate the current evidence and the use of TMDs in ACFs in New Zealand and subsequently develop interventions to improve nutritional intake and safety for aged care residents with dysphagia. Intervention one included the development of tailored implementation plans for ACFs to meet the International Dysphagia Diet Standardisation Initiative (IDDSI) guidelines. Intervention two included benchtop consumer testing and clinical efficacy of energy and protein-enriched pureed meat on aged care residents with dysphagia. Methods: Prior to commencing the investigational studies, two systematic reviews and meta-analyses were conducted to identify gaps in existing literature related to the nutritional outcomes and interventions of TMDs. A six-month pre-post implementation study was conducted in five ACFs using a mixed-methods design, including mealtime observation, interviews, surveys and meal audits. In addition, mealtime services and nutrition intake were examined post-intervention using a cross-sectional design. Meanwhile, a group of dietitians, speech-language therapists and community-dwelling older adults conducted consumer testing and focus group discussions regarding the currently available texture-modified foods. A twelve-week crossover randomised controlled intervention with hydrolysed meat was conducted in two ACFs involving 22 residents on pureed diets. Nutrition intake and nutritional status were assessed. Findings: In reviewing the literature, moulded food appears to improve dietary intake and nutrition status in residents on TMDs, while traditional TMDs had inadequate dietary intake. Following the six-month tailored intervention, the overall IDDSI compliance increased by 46% post-intervention (p<.0001). Staff scored higher in dysphagia and IDDSI knowledge (p<.0001). However, TMD menus failed to meet all nutrition requirements, foodservice and clinical standards. Residents requiring pureed diets had inadequate intake without oral nutritional supplements. Nutrition intake (energy: 147±285 kcal, p=0.02, protein 4±7 g, p=0.04) and weight (1.3±1.7 kg) significantly improved with hydrolysed meat consumption. The clinical trial highlighted the value of hydrolysed meat as an option for ACFs to provide to patients. Conclusions: TMDs represent a challenge to foodservice organisations supporting ACFs, and through systematic reviews, observations and controlled trials, the standardisation of TMD provision needs to be enhanced and an emphasis should be placed on the nutritional outcomes of TMD consumers in ACFs.