Keeping Consumers Safe: Food Providers' Perspectives on Pureed Food

Keller, Heather; Duizer, Lisa

doi:10.1080/21551197.2014.927303

Cited by 11 publications

(5 citation statements)

References 26 publications

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“…Previous research revealed that the intake of texture-modified diets usually lack appearance and taste [29] and are accompanied by lower energy and protein intake compared to usual meals [30]. Therefore, we reshaped the texture-modified diet.…”

Section: Discussionmentioning

confidence: 99%

An Individualised Nutritional Intervention Concept for Nursing Home Residents with or at Risk of Malnutrition: An enable Study

et al. 2020

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Dietary intake and requirements in nursing home (NH) residents vary individually, but concepts for individualised interventions are currently lacking. Therefore, we present an individualised modular nutritional intervention concept for NH residents with (risk of) malnutrition and describe its application and acceptability. Three enrichment modules—a sweet and a savoury protein cream (40 g, 125 kcal, 10 g protein) and a protein-energy drink (250 mL, 220 kcal, 22 g protein)—were offered to residents of two German NHs single or in combination in five levels of enrichment from level 0 (no enrichment) to 4 (all enrichment modules) to compensate for individual energy and protein deficiencies. Residents with chewing and/or swallowing difficulties received reshaped instead of usual texture-modified meals. The intervention concept was applied to 55 residents (Mean age of 84 ± 8 years, 76.0% female, 25.5% malnutrition). Despite (risk of) malnutrition, 18.2% received no enrichment (level 0). Level 1 was allocated to 10.9%, level 2 to 27.3%, level 3 to 20.0% and level 4 to 23.6% of the residents. 32.7% received reshaped texture-modified meals (RTMM). Participants consuming RTMM were more often assigned to level 4 than residents receiving usual meals (38.8% vs 16.2%). We proposed and successfully applied an individualised modular nutritional intervention concept to NH residents with (risk of) malnutrition. In the next step, the effects of the concept and its transferability to other NHs need to be demonstrated.

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Section: Discussionmentioning

confidence: 99%

An Individualised Nutritional Intervention Concept for Nursing Home Residents with or at Risk of Malnutrition: An enable Study

et al. 2020

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“…Carers’ beliefs that modified diets are unpalatable also contribute to non-compliance. In a recent study of staff perceptions of pureed food, most had a negative view describing such food with terms like ‘tasteless’ and ‘mush’; positive comments such as ‘tasty’ and ‘aromatic’ mainly came from allied health professionals and dietary-nutrition staff [ 64 ].…”

Section: Discussionmentioning

confidence: 99%

Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified?

O’Keeffe

2018

BMC Geriatr

111

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BackgroundAlthough modifying diets, by thickening liquids and modifying the texture of foods, to reduce the risk of aspiration has become central to the current management of dysphagia, the effectiveness of this intervention has been questioned. This narrative review examines, and discusses possible reasons for, the apparent discrepancy between the widespread use of modified diets in current clinical practice and the limited evidence base regarding the benefits and risks of this approach.DiscussionThere is no good evidence to date that thickening liquids reduces pneumonia in dysphagia and this intervention may be associated with reduced fluid intake. Texture-modified foods may contribute to undernutrition in those with dysphagia. Modified diets worsen the quality of life of those with dysphagia, and non-compliance is common. There is substantial variability in terminology and standards for modified diets, in the recommendations of individual therapists, and in the consistency of diets prepared by healthcare staff for consumption. Although use of modified diets might appear to have a rational pathophysiological basis in dysphagia, the relationship between aspiration and pneumonia is not clear-cut. Clinical experience may be a more important determinant of everyday practice than research evidence and patient preferences. There are situations in the management of dysphagia where common sense and the necessity of intervention will clearly outweigh any lack of evidence or when application of evidence-based principles can enable good decision making despite the absence of robust evidence. Nevertheless, there is a significant discrepancy between the paucity of the evidence base supporting use of modified diets and the beliefs and practices of practitioners.ConclusionThe disconnect between the limited evidence base and the widespread use of modified diets suggests the need for more careful consideration as to when modified diets might be recommended to patients. Patients (or their representatives) have a choice whether or not to accept a modified diet and must receive adequate information, about the potential risks and impact on quality of life as well as the possible benefits, to make that choice. There is an urgent need for better quality evidence regarding this intervention.

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“…Apply the International Dysphagia Diet Standardization Initiative framework in the prescription, preparation, and assessment of TMDs and thickened liquids to facilitate consistent communication between nursing home staff, carers, and professionals, and reduce variability in the preparation, assessment, and prescription of TMDs and thickened liquids (41).…”

Section: Tablementioning

confidence: 99%

Texture-Modified Diet for Improving the Management of Oropharyngeal Dysphagia in Nursing Home Residents: An Expert Review

Ballesteros-Pomar¹,

Cherubini²,

Keller³

et al. 2020

The Journal of nutrition, health and aging

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Objectives This paper provides evidence-based and, when appropriate, expert reviewed recommendations for long-stay residents who are prescribed texture-modified diets (TMDs), with the consideration that these residents are at high risk of worsening oropharyngeal dysphagia (OD), malnutrition, dehydration, aspiration pneumonia, and OD-associated mortality, poorer quality of life and high costs. Design Nestlé Health Science funded an initial virtual meeting attended by all authors, in which the unmet needs and subsequent recommendations for OD management were discussed. The opinions, results, and recommendations detailed in this paper are those of the authors, and are independent of funding sources. Setting OD is common in nursing home (NH) residents, and is defined as the inability to initiate and perform safe swallowing. The long-stay NH resident population has specific characteristics marked by a shorter life expectancy relative to community-dwelling older adults, high prevalence of multimorbidity with a high rate of complications, dementia, frailty, disability, and often polypharmacy. As a result, OD is associated with malnutrition, dehydration, aspiration pneumonia, functional decline, and death. Complications of OD can potentially be prevented with the use of TMDs. Results This report presents expert opinion and evidence-informed recommendations for best practice on the nutritional management of OD. It aims to highlight the practice gaps between the evidence-based management of OD and real-world patterns, including inadequate dietary provision and insufficient staff training. In addition, the unmet need for OD screening and improvements in therapeutic diets are explored and discussed. Conclusion There is currently limited empirical evidence to guide practice in OD management. Given the complex and heterogeneous population of long-stay NH residents, some ‘best practice’ approaches and interventions require extensive efficacy testing before further changes in policy can be implemented.

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Keeping Consumers Safe: Food Providers' Perspectives on Pureed Food

Cited by 11 publications

References 26 publications

An Individualised Nutritional Intervention Concept for Nursing Home Residents with or at Risk of Malnutrition: An enable Study

An Individualised Nutritional Intervention Concept for Nursing Home Residents with or at Risk of Malnutrition: An enable Study

Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified?

Texture-Modified Diet for Improving the Management of Oropharyngeal Dysphagia in Nursing Home Residents: An Expert Review

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