Texture modified diet in German nursing homes: availability, best practices and association with nursing home characteristics

Abstract

BackgroundFor nursing home (NH) residents with swallowing or chewing problems, appealing texture-modified-diets (TMD) need to be available in order to support adequate nutrition. The aim of this study was to describe the availability of TMD and best practices for TMD in German NHs and to identify related NH characteristics.MethodsInformation on NH characteristics, available texture-modified (TM)-levels (soft, “minced & moist”, pureed) and implemented best practices for TMD (derived from menu plan, separately visible components, re-shaped components, considering individual capabilities of the resident) was collected in a survey in German NHs. The number of TM-levels as well as the number of best practices for TMD were tested for their association with 4 structural, 16 operational and 3 resident-related NH characteristics.ResultsThe response rate was 7.2% (n = 590) and 563 NHs were included. The vast majority of NHs (95.2%) reported offering “minced & moist” texture and 84.2% preparing separately visible meal components. Several operational characteristics were more frequently (p < 0.05) reported from NHs offering three TM-levels (27.7%) or four best practices for TMD (13.0%) compared to NHs offering one TM-level (28.4%) or one best practice for TMD (20.1%): special diets and delivery forms (e.g. fingerfood 71.2% vs 38.8%; 80.8% vs. 44.3%), written recipes (69.9% vs. 53.1%; 68.5% vs. 53.9%), a dietetic counseling service (85.9% vs. 66.3%; 89.0% vs. 65.2%), a quality circle for nutritional care (66.7% vs. 43.8%; 71.2% vs. 50.4%), regular staff training (89.7% vs. 73.1%; 95.9% vs. 74.8%) and process instructions (73.7% vs. 53.1%; 75.3% vs. 47.8%). No associations were found regarding structural and resident-related NH characteristics, except a higher percentage of residents receiving TMD in NHs with three compared to one TM-level (median 16.3% vs. 13.2%, p = 0.037).ConclusionAll participating NHs offer some form of TMD, but only a small number offers a selection of TMD and pays adequate attention to its preparation. Operational NH characteristics – which might reflect a general nutritional awareness of the NH – seem to be pivotal for provision of TMD, whereas neither structural nor resident-related characteristics seem to play a role in this regard.

A Comparison of Dietary Intake and Nutritional Status between Aged Care Residents Consuming Texture-Modified Diets with and without Oral Nutritional Supplements

“…The compromised carbohydrate intake can be explained by the similar results found in New Zealand aged care facilities where only 26%, 63% and 79% of the TMD menus offered adequate portion sizes of carbohydrate, protein and vegetables, respectively [ 43 ]. To ensure the nutrition quality of TMD menus, dietitians should conduct menu audits regularly [ 44 ]. Foodservice staff are required to follow dietitian recommended standardised recipes to allow consistent and highly nutritious meal productions [ 40 ].…”

Oral conditions and other symptoms among older persons in long‐term care facilities during the end of life

“…Clearly, oral conditions were associated with malnutrition as well. Older adults with oral health problems in long‐term care facilities suffer from malnutrition, as many as 85% of the residents in long‐term care facilities 45 . Oral abilities (e.g., swallowing and chewing difficulties) were another factor that caused malnutrition in long‐term care facilities.…”

Three-dimensional food printing: its readiness for a food and nutrition insecure world

“…For example, TMF are commonly served as ‘ice cream balls’ because of the portion scoops. In addition, those on TMF diets face persistent and severely restrictive food varieties, representing a silent food insecurity issue for these vulnerable people (41–43) . The transition to TMF from standard diets leads to reduced appetite (44) ; lower intakes of vitamins A and E (45) , protein and fluid (46) and higher weight loss (42) .…”