Far from joyful social occasions, mealtimes can be stressful and isolating for people with swallowing difficulties. They may feel anxious about choking, or frustrated by how long it takes to get food down, and by their inability to be part of the conversations happening around them.
As a result, it’s common for those with swallowing difficulties to eat less than they need, and therefore become malnourished and underweight.
Although the swallowing difficulties themselves often can’t be fixed, there is a lot that can be done to enhance the dining experience and improve health outcomes, says Dr Anna Miles, a lecturer and clinician specialising in swallowing disorders.
“The biggest risks for people with dysphagia [swallowing difficulties] are malnutrition and depression, so anything that makes food more appealing and makes them want to eat more is helpful.”
Studies in rest homes have shown that if you create a pleasant dining experience, people will spend longer at the table and consume more. Soft background music, tablecloths, floral centrepieces and menus can make a meal feel like a special event rather than a chore. Anna says that rest homes have worked hard to make dining rooms look like cafes and serve food buffet-style, allowing residents to make choices – another way to enhance enjoyment.
“The problem is that it is so much harder for those who have a diet restriction,” Anna says. “If all the food is on a platter in the middle of the table, you tend to eat a bigger meal. But that is restrictive for those with swallowing problems, who need different food.
“The fortification in The Pure Food Co foods means that people can eat smaller portions and finish their meal at the same time as their dining companions while still getting the nutrition they need. They don’t feel excluded by being the last ones to finish.”
There are a number of other ways to make mealtimes more enjoyable for those on texture-modified diets, such as making it clear what each dish is, a challenge when you are dealing with puree.
“In the real world, we don’t eat a meal and not know what it is,” says Anna. “In residential care, the food is often just put in front of you. If you have menu cards that sit alongside the plate, you can see what it is you are eating.”
Maintaining separation between different foods is important, too. You don’t want to swirl together the peas and the chicken and the sweet potato into an unappetising melange. The brain takes flavour cues from colour and shape, so when working with texture-modified food, it’s helpful to use moulds to provide shape and to ensure that colours are vibrant and true.
“If you are serving roast lamb, you would not put it in a mould that looks like peas. If you change the colour of a vegetable, no-one can distinguish it. If you make my peas orange, I can’t tell they’re peas. It’s a bit like those psychology tests where you are looking at the word ‘green’ but it’s in red lettering so you say ‘red’. You can’t help yourself.”
Boosting the flavour of texture-modified food also encourages people to eat more. So does making sure food smells great and is served at the right temperature. “Anything that makes the meal more appealing is good.”
With The Pure Food Co texture modified products, you can create delicious combinations of classic foods and modern favourites specifically for those with swallowing difficulties. How about a Sunday roast followed by a Peanut Butter Slab Smoothie? Or a comforting serve of Fish Pie then some Butterscotch Cake?
Anna says it is important to consider the way food aromas will mix in a busy dining room. If most people are being served roast beef and those on texture-modified diets are getting smoked fish, there will be an unappetising clash.
“You are starting to see really good practices being put in place,” says Anna. “A third of rest-home residents have a swallowing problem or some sort of alteration to their teeth. It’s the most challenging dining room you will find anywhere.”