Texture modified food – the hidden challenges of preparing in-house
Creating delicious, nutritious and varied texture modified food (TMF) from scratch requires more effort than just blending and serving.
The right texture, consistency and fortification combine to make meals more enjoyable for residents on a texture-modified diet (TMD), while avoiding weight loss and subsequent malnutrition risk.[1] Getting texture modified food right is also a safety issue – foods that comply with IDDSI texture standards can help minimise choking risks[2].
In short, the food must be safe, delicious and highly nutritious to help improve residents’ nutrition and overall well-being. However, producing it to this high standard in-house can be surprisingly time-consuming and difficult.
Getting safe textures right every time
For residents eating a texture modified diet, the texture and consistency of their food is critical to their safety, but kitchen staff may not have the knowledge or training they need to get it right.[3] Terms and descriptions of the levels of modification vary greatly, along with information on how to achieve them.[3][4]
The variability of raw ingredients can also make it difficult to get the right texture, and staff behaviours can factor, too.[5] They may not always exactly follow recipes, and experienced cooks may prefer to experiment, improvise or follow their instincts.[6]
This could be one reason texture modified food prepared in-house can have less uniform food particle size and consistency.[7] A study in aged care found that staff did not widely use IDDSI terminology or testing methods, and some were unaware of them.[8]
These issues put facilities at increased risk of non-compliance and complaints, contribute to problems with safe swallowing, and can make mealtimes more stressful for residents and staff.[9] By comparison, commercially prepared texture modified food from The Pure Food Co better protects compliance and the safety of all residents, whether you have one facility or a large network of a hundred. The Pure Food Co also offers full traceability, from farm to fork, simplifying compliance reporting while increasing transparency and peace of mind.[10]
Ensuring adequate nutrition
Residents on a texture modified diet may be more at risk of weight loss, malnutrition and nutrient deficiencies. While most studies connect a texture modified diet with inadequate nutrition this may especially be true when food is prepared in-house.[7][13] When making texture modified food, recipes are often diluted with water, which means residents need a larger volume to achieve optimal nutrition.[11]
Enriching the food’s nutrition could help, but a study showed less than half of aged care facilities fortified their in-house texture modified food.[8],[17] Another showed that meals were being fortified with cream or full-cream milk powder, which impacted taste and texture.[11]
The texture modified meals from The Pure Food Co consistently provide sufficient Protein levels while being safer and more nutritious. [7][11]
Improving food presentation
How texture modified food looks on the plate can greatly impact residents’ food intake and well-being.[14] One study that looked into the perception of pureed diets reported that residents found the meals lacked variety in taste, appearance and smell.[15] Presented in uniform scoops, texture-modified foods are less visually appealing and reduce interest in the meal. However, the moulded texture modified food from The Pure Food Co may increase meal enjoyment, appetite and nutritional intake.[16],[17]
Efficient use of labour
A recent Time and Motion study conducted by The Pure Food Co illustrated that producing in house texture modified food requires extensive labour, equipment, space and capability. Up to 23 steps can be required just to produce one variety of food for an aged care facility.
The time savings of commercially prepared texture modified food offer more than financial benefits. Staff can dedicate more time to resident interactions, enhancing their overall experience and well-being. In one study, staff working at sites serving commercially prepared texture modified food reported time savings, fewer safety concerns and improved patient outcomes, including minimised hospitalisations.[11]
Better food for less
While cooking from scratch sounds appealing on the surface, the research suggests aged care facilities would be best to serve textured modified foods that have been carefully prepared in a commercial facility.
They tend to be safer, more cost-effective, compliant, nutritious and appetising. Staff can turn their attention away from blending, boiling, mashing, and managing stressful mealtimes and poor health outcomes, to focus on making life more enjoyable for residents.
Get in touch for more on how The Pure Food Co range of texture modified foods could help improve compliance, budgets and health outcomes across your facilities – Contact Us.
[1] W Wu XS, Miles A, Braakhuis AJ. Texture-Modified Diets, Nutritional Status and Mealtime Satisfaction: A Systematic Review. Healthcare (Basel). 2021 May 24;9(6):624. doi: 10.3390/healthcare9060624. PMID: 34073835; PMCID: PMC8225071.
[2] The International Dysphagia Diet Standardisation Initiative 2019 https://iddsi.org/framework/
[3] Cichero JA, Steele C, Duivestein J, Clavé P, Chen J, Kayashita J, Dantas R, Lecko C, Speyer R, Lam P, Murray J. The Need for International Terminology and Definitions for Texture-Modified Foods and Thickened Liquids Used in Dysphagia Management: Foundations of a Global Initiative. Curr Phys Med Rehabil Rep. 2013 Aug 24;1(4):280-291. doi: 10.1007/s40141-013-0024-z. PMID: 24392282; PMCID: PMC3873065.
[4] Niezgoda, H., Miville, A., Chambers, L., Keller, H. Issues and challenges of modified-texture foods in long-term care: A workshop report. Annals of Long-Term Care. 2012:20. 22-27. Link to full article
[5] National Dysphagia Diet Task Force, American Dietetic Association. National dysphagia diet: Standardization for optimal care. Chicago, Illinois: American Dietetic Association. 2002.
[6] Ilhamto N, Anciado K, Keller HH, Duizer LM. In-house pureed food production in long-term care: perspectives of dietary staff and implications for improvement. J Nutr Gerontol Geriatr. 2014;33(3):210-28. doi: 10.1080/21551197.2014.927306. PMID: 25105716.
[7] Dahl WJ, Whiting SJ, Tyler RT. Protein content of puréed diets: implications for planning. Can J Diet Pract Res. 2007 Summer;68(2):99-102. doi: 10.3148/68.2.2007.99. PMID: 17553196.
[8] Wu XS, Miles A, Braakhuis A. An Evaluation of Texture-Modified Diets Compliant with the International Dysphagia Diet Standardization Initiative in Aged-Care Facilities Using the Consolidated Framework for Implementation Research. Dysphagia. 2022 Oct;37(5):1314-1325. doi: 10.1007/s00455-021-10393-2. Epub 2022 Jan 7. PMID: 34993611.
[9] Austbø Holteng LB, Frøiland CT, Corbett A, Testad I. Care staff perspective on use of texture modified food in care home residents with dysphagia and dementia. Ann Palliat Med. 2017;6(4):310-318. doi:10.21037/apm.2017.06.24
[10] Wu X, Yousif L, Miles A, Braakhuis A. Exploring Meal Provision and Mealtime Challenges for Aged Care Residents Consuming Texture-Modified Diets: A Mixed Methods Study. Geriatrics. 2022; 7(3):67. https://doi.org/10.3390/geriatrics7030067
[11] Namasivayam AM, Steele CM. Malnutrition and Dysphagia in long-term care: a systematic review. J Nutr Gerontol Geriatr. 2015;34(1):1-21. doi: 10.1080/21551197.2014.1002656. PMID: 25803601.
[12] Peñalva-Arigita A, Prats R, Lecha M, Sansano A, Vila L. Prevalence of dysphagia in a regional hospital setting: Acute care hospital and a geriatric sociosanitary care hospital: A cross-sectional study. Clin Nutr ESPEN. 2019 Oct;33:86-90. doi: 10.1016/j.clnesp.2019.07.003. Epub 2019 Jul 24. PMID: 31451280.
[13] Wu XS, Miles A, Braakhuis A. Nutritional Intake and Meal Composition of Patients Consuming Texture Modified Diets and Thickened Fluids: A Systematic Review and Meta-Analysis. Healthcare (Basel). 2020 Dec 21;8(4):579. doi: 10.3390/healthcare8040579. PMID: 33371326; PMCID: PMC7767351.
[14] Chen, L., Hemsley, B. & Debono, D. The Impact of Food-Shaping Techniques on Nutrition, Mealtime Experiences, and Quality of Life for Older Adults in Aged Care Settings: A Systematic Review. Curr Nutr Rep 12, 744–766 (2023). https://doi.org/10.1007/s13668-023-00493-w
[15] Keller HH, Duizer LM. What do consumers think of pureed food? Making the most of the indistinguishable food. J Nutr Gerontol Geriatr. 2014;33(3):139-59. doi: 10.1080/21551197.2014.927302. PMID: 25105712.
[16] Okkels SL, Saxosen M, Bügel S, Olsen A, Klausen TW, Beck AM. Acceptance of texture-modified in-between-meals among old adults with dysphagia. Clin Nutr ESPEN. 2018 Jun;25:126-132. doi: 10.1016/j.clnesp.2018.03.119. Epub 2018 Mar 31. PMID: 29779807.
[17] Higashiguchi T. Novel diet for patients with impaired mastication evaluated by consumption rate, nutrition intake, and questionnaire. Nutrition. 2013 Jun;29(6):858-64. doi: 10.1016/j.nut.2012.12.016. Epub 2013 Feb 28. PMID: 23453553.
