Resident nutrition
is when a ‘safe food’ has been exposed to an allergen containing food, and can occur at any point when food is being handled, including preparation, cooking, storage, and serving. Therefore, it can be challenging to avoid, especially if homes are scratch cooking for many residents with varying dietary needs and allergies. Using pre-prepared meals can help to mitigate some of these risks for care homes as they will have been produced in a strictly controlled environment, safely packed, and labelled – providing a safe and more convenient option when catering for diverse dietary needs. Whether scratch cooking or pre-
packaged allergen free meals, regular risk assessments of the care home’s food handling and preparation processes should be conducted. This can help identify potential hazards and areas for improvement in managing food allergies. Personalised nutrition pathways can support care homes to implement appropriate measures, so they can effectively cater to the dietary needs of each resident and navigate food allergies creating a safe dining environment for all residents.
Texture modified diets and dysphagia Another common specialist diet seen in care homes is a texture modified diet, which can be used for the management of swallowing difficulties (dysphagia). Individuals living with dysphagia have a heightened risk of malnutrition due to an array of physical and psychological factors, such as a fear of choking causing food avoidance, aversion to texture modified meals, mealtime fatigue, and embarrassment – all of which negatively impact food intake. Dysphagia is highly prevalent in care homes. The Nourishing Lives report found 8 out of 10 homes surveyed reported having residents living with dysphagia, and 1 in 3 of these residents they believed was suffering from malnutrition as a result.2 One factor that can have a significant impact on an individual’s nutritional intake, as well as their mealtime enjoyment, is meal presentation, with 7 out of 10 care homes believing that the ‘joy of eating’ was lost when serving residents pureed food, due to it being poorly presented.2
This statistic
highlights the importance of visually appealing texture modified meals to ensure that individuals living with dysphagia meet their nutritional requirements. Many people ‘eat with their eyes’ and, therefore, poor meal presentation can
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lead to a reduced intake or refusal of meals altogether due to its key role in appetite stimulation.
The visual appeal of a texture
modified meal can further impact the mealtime experience due to feelings of embarrassment. The noticeable difference in a texture modified meal may draw attention to an individual’s clinical condition, exposing them to judgment from others and making the mealtime a source of social anxiety. This can potentially lead to the avoidance of social situations altogether, which, in turn, can negatively impact the mental wellbeing of residents living with dysphagia. It is therefore important from both a physical and emotional perspective to consider the visual appearance of a modified meal to best support those in your care.
In a social setting, if an individual can eat a safe texture modified meal that closely resembles a regular textured dish, it may reduce these feelings of embarrassment and social anxiety, allowing for a more positive and comfortable mealtime experience. Also, providing a visually appealing meal has shown to increase meal consumption from 25 per cent to 75 per cent.7
Presentation is just one of many factors that can support people living with dysphagia to eat well. Portion size can also impact nutritional intake, since individuals living with dysphagia may often struggle with mealtime fatigue. Therefore, it is essential they have access to nutritionally dense meals in smaller portions. Choice and variety are also essential to support a balanced diet and prevent boredom, allowing residents to make meal choices
based on their preferences each day – which is likely to lead to better intake. Dysphagia is not a static condition – it can change for the better or worse, and for this reason it is essential to work with Speech and Language Therapists (SLTs) who will provide an assessment and recommend the most suitable texture. Staff should be trained on the different
food textures, which are defined by the International Dysphagia Diet Standardisation Initiative (IDDSI). It is essential that they understand the severity of not providing the recommended texture and that any adaptions, for example, adding normal gravy to a Level 4 Purée meal, will affect the texture, and therefore the safety, of the meal – with the potential for fatal consequences.
A pivotal role
In conclusion, care homes play a pivotal role in supporting the health and wellbeing of their residents. The implementation of personalised nutritional pathways is essential in addressing the complex dietary needs of these residents, ensuring they receive the necessary nutritional support while also enjoying their meals. Additionally, comprehensive staff training and collaboration with healthcare professionals are vital in managing specialist diets, thereby reducing risks and improving care quality. By prioritising these strategies, care homes can create a safe and supportive environment that promotes the physical and emotional wellbeing of their residents, ultimately leading to better health outcomes and a higher quality of life.
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www.thecarehomeenvironment.com November 2024
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