Texture-Modified Diet for Improving the Management of Oropharyngeal Dysphagia in Nursing Home Residents: An Expert Review

Abstract

Objectives This paper provides evidence-based and, when appropriate, expert reviewed recommendations for long-stay residents who are prescribed texture-modified diets (TMDs), with the consideration that these residents are at high risk of worsening oropharyngeal dysphagia (OD), malnutrition, dehydration, aspiration pneumonia, and OD-associated mortality, poorer quality of life and high costs. Design Nestlé Health Science funded an initial virtual meeting attended by all authors, in which the unmet needs and subsequent recommendations for OD management were discussed. The opinions, results, and recommendations detailed in this paper are those of the authors, and are independent of funding sources. Setting OD is common in nursing home (NH) residents, and is defined as the inability to initiate and perform safe swallowing. The long-stay NH resident population has specific characteristics marked by a shorter life expectancy relative to community-dwelling older adults, high prevalence of multimorbidity with a high rate of complications, dementia, frailty, disability, and often polypharmacy. As a result, OD is associated with malnutrition, dehydration, aspiration pneumonia, functional decline, and death. Complications of OD can potentially be prevented with the use of TMDs. Results This report presents expert opinion and evidence-informed recommendations for best practice on the nutritional management of OD. It aims to highlight the practice gaps between the evidence-based management of OD and real-world patterns, including inadequate dietary provision and insufficient staff training. In addition, the unmet need for OD screening and improvements in therapeutic diets are explored and discussed. Conclusion There is currently limited empirical evidence to guide practice in OD management. Given the complex and heterogeneous population of long-stay NH residents, some ‘best practice’ approaches and interventions require extensive efficacy testing before further changes in policy can be implemented.

Beverage Type and Hydration Parameters in Older Persons Following a Texture-Modified Diet and Living in Long-term Care Residences

“…The main objective of this study was to determine if speci c types and patterns of beverage intake are related to better outcomes of hydration parameters in older people that follow a texture-modi ed diet. The importance of this study lies in the fact that this population group presents a higher risk of dehydration and is associated with several consequent medical complications [16]. Our ndings con rm that more than 50% of the analysis performed in the volunteers showed parameters of dehydration or risk of dehydration.…”

Texture-Modified Diets, Nutritional Status and Mealtime Satisfaction: A Systematic Review

“…However, as an observational study, it is not possible to determine whether the outcomes were coincidental. Though nutritional status was found to be routinely screened in nursing homes, diet quality is one of the biggest challenges of clinical management which can result in malnutrition [ 68 , 69 ]. The previous review summarised that the positive improvement in nutrition intake was found using fortification and shaped TMDs [ 32 ].…”

“…The previous review summarised that the positive improvement in nutrition intake was found using fortification and shaped TMDs [ 32 ]. Implementing nutrition enrichment strategies such as fortified food or supplements should be considered in dysphagic management for malnourished patients and those who are at risk of malnutrition [ 68 , 70 ].…”

Interventions for Nursing Home Residents with Dysphagia—A Scoping Review

“…Based on the evidence identified, this scoping review demonstrates sparse knowledge about which interventions affect nursing home resident's dysphagia. It is common practice to serve a texture-modified diet to improve food intake and to prevent aspiration in nursing home residents, but a review document limited evidence for the effect of the intervention [44]. Two studies in this scoping review demonstrate increased BMI when a texturemodified diet was served, but the studies did not measure the effect on aspiration [38,41], It seems that multi-component interventions, including staff training [36], training of residents [28,29], and/or next of kin [35], might be successful.…”