Assessing adherence and exploring barriers to provision of prescribed texture modifications for dysphagia in a residential aged care facility in rural Australia

Hill, Cindy; Clapham, R P; Buccheri, A M; Field, Minna; Shee, Anna Wong; Alston, Laura

doi:10.1080/17549507.2021.1953144

Cited by 4 publications

(6 citation statements)

References 20 publications

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“…The current study identified positive practices and several challenges related to foodservice production, serving procedures, and residents’ perception of the dining environment contributing to a less satisfactory mealtime experience. The findings of this study are in agreement with the recent studies that examined the mealtime challenges, menus, and food choices of TMD in aged care facilities [ 21 , 43 , 44 , 45 , 46 , 47 ]. It is important to note that, despite the recent IDDSI implementations addressing the criteria of safe and nutritious TMDs, further quality improvements on TMD service are still required.…”

Section: Discussionsupporting

confidence: 92%

“…Despite all levels of TMDs being offered, the TMD menus had inadequate variability and food choices. Similar results were found in Australian aged care facilities, where the TMD menus offered fewer choices than regular menus and meals adhered poorly to the planned menus [ 46 , 47 , 48 ]. In Miles et al’s study, residents on TMDs reported that sweet snacks brought them the most pleasure [ 44 ].…”

Section: Discussionsupporting

confidence: 73%

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Exploring Meal Provision and Mealtime Challenges for Aged Care Residents Consuming Texture-Modified Diets: A Mixed Methods Study

Yousif

Miles

et al. 2022

Geriatrics

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Dysphagia has become more prevalent with age. Thus, the demand for texture-modified diets (TMDs) has increased. While the nutritional perspectives have been studied, the provision of TMDs and mealtime practice has received less attention. This study aimed to explore the TMD provision and mealtime challenges of residents requiring TMDs in aged care facilities. The study was conducted across five aged care facilities using a mixed methods design involving 14 TMD menu audits by a foodservice dietitian, 15 mealtime observations, and semi-structured interviews with residents and staff (n = 18). TMD menus failed to meet all nutrition requirements and foodservice and clinical standards based on the dietitian NZ foodservice and nutrition audit tool. A content analysis offered three main themes: (1) Foodservice production. Inconsistent quality and meal portions were observed. The variety, choice, and portion size of TMDs required improvement based on the residents’ preferences; (2) Serving procedures. There was a lack of standardisation of meal distribution and feeding assistance; and (3) Dining environment. The dining room set-up varied across facilities, and residents expressed different preferences towards the dining environment. There is a need to improve staff awareness of mealtime consistency and optimise feeding assistance. The dining environment should be individualised to accommodate residents’ psychosocial needs. Standardised policies and continuous training can facilitate quality mealtime implementation.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 73%

Exploring Meal Provision and Mealtime Challenges for Aged Care Residents Consuming Texture-Modified Diets: A Mixed Methods Study

Yousif

Miles

et al. 2022

Geriatrics

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“…This study confirms reports from other countries that nurseinitiated dietary restrictions and changes are not unusual, and that the most common approach is to introduce a more restrictive diet such as thicker liquids or pureed food (4)(5)(6)(7)(8). Sometimes this reflects difficulty accessing SLT services.…”

Section: Discussionsupporting

confidence: 86%

“…A survey conducted by Nursing Homes Ireland noted that some had to rely on SLTs provided by nutritional companies or to ask residents to pay for private assessments (2). Some reports also suggest that, in the absence of SLT support, nurses may sometimes themselves initiate or change modified diets (modified texture food and thickened liquids) for residents with dysphagia (5)(6)(7)(8). In this study we sought to determine the approach of Irish NH nursing staff in these circumstances.…”

Section: Introductionmentioning

confidence: 99%

“In Limbo”—use of, and alterations to, modified diets by nursing home staff in the absence of timely specialist support

Okon,

Chan,

O’Keeffe

2024

Front. Rehabil. Sci.

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BackgroundDysphagia is common in nursing home (NH) residents. Staff may not always be able to access speech and language therapist (SLT) assessments in a timely manner and there are some reports of nurses initiating or changing modified diets in these circumstances.MethodsA mixed quantitative and qualitative approach was used to analyse responses to an online anonymized survey of senior nurses working in Irish NHs. They were asked about their experience of delays accessing SLT services and whether they would ever initiate or change modified diets. Respondents were asked if they would give water to a thirsty resident, prescribed mildly thick liquids, who demanded it on a hot day because thickened fluid was not thirst quenching.ResultsOf 77 nurses surveyed, 63 (82%) responded. Three quarters reported delays accessing SLT services sometimes or often. Thirty-four (54.0%) would not give the thirsty resident water. About 70% reported that thickened fluids or modified texture diets were started without SLT sometimes or often. A third of respondents would thicken fluids or modify food to a greater extent than previously recommended but very few would make a diet less restrictive. The main themes that emerged from the comments provided were related to the uncertainty and dilemmas created for staff, what mitigating actions they might take in those circumstances and the need for better guidance and better access to SLT services.DiscussionDelays accessing SLT services are common for Irish NHs, and staff may initiate or change modified diets themselves in these circumstances. The responses suggest a widespread, and unjustified, belief that thicker or more modified is better for those with dysphagia. Clear and accurate guidance, and a better SLT service, is needed for NH staff.

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“…Internationally, the International Dysphagia Diet Standardization Initiative (IDDSI) has been implemented in many countries worldwide, proposing five texture-modified diet levels and five thickened fluid levels [28]. A significant challenge of texture modification in aged care is the low adherence to prescribed texture-modified diets [29,30 ▪ ]. Wu et al [31 ▪ ] examined the effectiveness of IDDSI-tailored intervention delivery in aged care facilities and indicated improved compliance with texture-modified diet production, highlighting the importance of staff-targeted education in enhancing adherence to appropriate texture levels.…”

Section: Introductionmentioning

confidence: 99%

Malnutrition in aged care: interplay between dysphagia and diet

Miles

Braakhuis

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review This review aims to deliver expert insights on the current advances and challenges in managing malnutrition in aged care settings, with a specific emphasis on the interaction between dysphagia and diet. Recent findings Several reviews identify the high prevalence of dysphagia in aged care facilities and highlight the correlation between dysphagia and malnutrition. Recent studies underscore the importance of nutrition and cancer screening and assessment, yet highlight the lack of consensus on the definitive tools to be used. There is a growth in employing innovative implementations for enhancing swallowing function and optimizing texture-modified foods. Summary Early identification and strategic interventions are vital for managing malnutrition and dysphagia in aged care facilities, as these conditions are widespread and lead to a higher risk of complications. Although nutritional strategies have shown potential in enhancing oral intake for residents requiring texture-modified foods, lack of investigation on functional outcomes and long-term impact have been highlighted, emphasizing the need for continued research and development of effective assessment tools and targeted interventions to optimize the care for this at-risk group.

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Assessing adherence and exploring barriers to provision of prescribed texture modifications for dysphagia in a residential aged care facility in rural Australia

Cited by 4 publications

References 20 publications

Exploring Meal Provision and Mealtime Challenges for Aged Care Residents Consuming Texture-Modified Diets: A Mixed Methods Study

Exploring Meal Provision and Mealtime Challenges for Aged Care Residents Consuming Texture-Modified Diets: A Mixed Methods Study

“In Limbo”—use of, and alterations to, modified diets by nursing home staff in the absence of timely specialist support

Malnutrition in aged care: interplay between dysphagia and diet

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