Diet is an important part of caring for the elderly. Extra care is necessary when the state of health requires a change in diet or consistency of food.
WHAT IS DYSPHAGIA?
Dysphagia, or swallowing issues, means difficulties in swallowing certain types of food or drink. A special diet of a suitable consistency can be served according to the resident’s abilities. Food can be minced or pureed, for example.
What is a pureed meal?
A pureed consistency is smooth with no lumps. All components of a meal – meat, fish, vegetable and fruit – can be pureed. Once the main ingredient has been pureed, cream, egg, mashed potato or a gelling agent can be added. A whole meal of suitable consistency can be presented in a pureed form.
Good food hygiene practices should be strictly followed. Chefs should receive adequate training in the rules and techniques required. These meals should be served as part of an overall nutritional programme designed to fulfil the special needs of elderly persons.
Given these constraints, some residential homes prefer to source meals from nutrition specialists.
Who is pureed food for?
Swallowing difficulties may be the consequence of several pathologies: neurological problems, cancer, handicap, etc. A pureed diet can be suitable for:
- Dependent elderly persons,
- Polyhandicapped persons (children and adults),
- Post-stroke or postoperative patients (especially ear, nose and throat conditions)
- Cancer patients (especially of the tongue, mouth and throat) or those suffering from mucositis.
The issues may be passing, temporary or long-term. Meal consistency may vary according to ability to swallow and chew and regular monitoring is necessary to ensure that dishes are of a suitable consistency.
What is the right consistency?
In France a study conducted in 2007 by the GEMRCN for catering services drew up the following guidelines:
- Liquid: can be drunk out of a glass or through a straw.
- Thin Puree: smooth consistency for both meat and vegetables.
- Thick Puree: meat is minced, vegetables are mashed or very tender.
- Minced: only meat is minced, except if the protein element is tender.
In 2011, the ANAP (Agence National d’Appui à la Performance) published a guide to help French residential care homes introduce suitable meals.
In 2015, an international group of speech therapists introduced a common framework to standardise terminology and practices: the International Dysphagia Diet Standardisation Initiative framework. It comprises five grades for food:
- Grade 7: Regular
- Grade 6: Soft and bite-sized
- Grade 5: Minced and moist
- Grade 4: Pureed
- Grade 3: Liquidised
Elderly persons in residential care
Meal quality greatly affects the level of satisfaction for residents and their families. The meals served should take account of tastes, habits and constraints. However, catering for individual tastes can be problematic for many establishments.
Not to mention the strict hygiene requirements.
Determining the most suitable consistency can be an issue, due to a lack of training, a lack of speech therapists and the responsibility shouldered by staff.
The problem can be addressed in several ways:
- Dishes made on site,
- Dishes made off-site and delivered,
- Supply of ready meals to which chefs can add a personal touch (sauce, presentation etc.).
Great care should be taken with presentation. A colourful, appealing dish stimulates the appetite. Herbs and spices can be added according to taste.