Eating with our senses: rethinking texture-modified foods

Ensuring consumers with dysphagia have their food texture needs met is important for their safety but that doesn’t mean the joy of eating should be sacrificed. 

There is no one-size-fits-all approach for texture-modified food and drinks and aged care Quality Standards state that consumers must have enough nutrition and hydration to maintain good health and reduce the risks of malnutrition and dehydration.

But while the International Dysphagia Diet Standardisation Initiative (IDDSI) Framework outlines standardised names and descriptions of texture-modified food and drinks across 8 levels, the presentation of food, aroma and flavour can come down to the choices of the people making it. 

Have you ever thought about how the texture-modified food in your organisation is being presented to you residents? And most importantly – what does it taste like?

Most dietitians and chefs say the whole dining experience can impact our appetite. Most of us eat with our senses and appetites are often stimulated by the appearance and smell of the food we eat. 

Aged care consumers can lose their appetite based on what is being put in front of them, particularly if they require modified foods but what is presented to them looks unappealing and lacks flavour. 

With strict malnutrition reporting in place for aged care providers, making your food as appealing as possible to consumers helps you stay compliant whilst keeping the older people in your care healthy and full and making mealtimes a pleasant experience.

It’s important to put thought and care into the design of modified meals when they’re still an idea on paper to ensure that the end product has maximum flavour and visual impact. Consumers have the right to safe and appealing food even if it has to be modified for their swallowing capacity.

Plating up

Head of Food Culture at HammondCare, Sarah Brown, said putting care and consideration into the recipes and construction of these modified foods is important for consumer dignity and overall nutritional intake. 

Whether it’s a chef, a cook or a carer that is preparing the food, the recipes should be thoughtful in terms of flavour for all the different textures.

“Presenting these nutritious meals in an appealing way improves meal acceptance and then the amount that a person is willing to consume and therefore, the nutrients that they’re able to consume,” she explained.

“We should have a variety of colours on the plate and can use food moulds, scoops, piping or quenelle to present each of the coloured components and keep them individual so they’re not all bleeding into each other. Or you could keep each component separate with different ramekins or different plates.”

Flavour!

Often a liquid needs to be added to food in the modification process to change the texture, and that shouldn’t always be water. If a liquid is required to assist in texture modifying a food it needs to be both flavourful and nutritious. 

“We want to go for more flavourful and nourishing liquids like cream, coconut cream or stock so that it is actually adding to the meal,” Sarah said. 

“The meal might not appear in a familiar way but then if those flavours are familiar and have been added in the cooking process and the texture modification process, that’s really going to entice the individual to continue enjoying that meal.”

Texture-appropriate garnishes

Using a version of basil oil, for example, or a smooth coulis for a dessert is a thoughtful way to add to the enjoyment process. Build these elements into the recipe planning and development process to ensure that every texture will be as appealing as the next.

Commission recommendations

The Aged Care Quality and Safety Commission outlines ways to maintain the appeal of food and drinks requiring modification. To ensure your consumers feel content with their foods and drinks, it is important for staff to be able to tell residents what the pureed food is, as it can all look the same.

Other recommendations for visual presentation include:

• Piping different foods into varied shapes and patterns 
• Layering pureed fruit and custard in a clear container
• Layering minced meat, vegetables and sauce like lasagne 
• Providing sharp knives to cut up foods where needed to avoid a ‘mashed’ look 
• Including regular menu items where they are still suitable such as mousse, pate and custard

And just because what’s on the plate had been adjusted to meet a resident’s needs, doesn’t mean that the overall dining experience of a resident should be compromised as well.

Some general suggestions to make mealtimes a positive experience for all residents are:

• Consider the dining room atmosphere – the table layouts, lighting, decorations, table coverings and settings. Ventilation, glare, and background noise are also important factors to consider in a resident’s eating environment. 
• Ensure all meals look appetising and served at an appropriate temperature, regardless of texture.
• Support independence and dignity by empowering residents to eat and drink using modified tables, cutlery and aids, if required. Provide mealtime assistance only if needed or requested. 
• Ensure residents have adequate time to eat, drink and socialise and do not remove food before checking if the person has finished. 
• Avoid using clothing protectors to maintain residents’ dignity unless they are requested or they are absolutely necessary for excessive food spillage. 
• Involve residents in the planning and assessment of their dining experience by asking for suggestions and feedback.
• When serving texture modified foods, explain to residents what the food is.
• Avoid stirring and/or mixing the food and don’t mix texture modified meals all together, as it is undignified. 
• Provide culturally-appropriate food and cutlery including chopsticks, spoons, forks and handwashing bowls for those who want to use their hands to eat. 
• Provide time for cultural prayer or traditions during mealtime. 
• Encourage all staff to sit down with residents during mealtimes.

The Commission has made a number of guides available on its website for providers to help improve the eating experience and standard of nutrition for aged care residents.

Texture-modified food shouldn’t just be a mess on a plate. Taking time to consider a client’s needs, preferences and modification requirements is an important part of ensuring nutrition is upheld and overall food enjoyment is achieved.