It’s a common situation we see all too often in aged care facilities: a resident doesn’t want to eat their meal.
The person may not be able to communicate why they don’t want to eat, they may not like the meal, or the food may be too difficult for them to eat. They may not eat because the staff member helping them is distracted. Or, the resident simply may not be hungry.
Of course, making sure that aged care residents consume enough nutritious food and drink is absolutely fundamental to the care they receive.
With some putting rates of malnutrition as high as 70 per cent in some aged care facilities, and with many aged care residents being frail and vulnerable, it’s crucial that we do all we can to help residents in aged care facilities eat at every meal.
Julie Cichero, Co-Chair, International Dysphagia Diet Standardisation Initiative, told HelloCare she has seen how getting kitchen staff to follow the meals they prepare out of the kitchen to spend time with the person actually eating the meal can make huge improvements to food services in nursing homes.
“When people from the kitchen come out and see the people who eat the food they have prepared for them, it gives the cooks, chefs and kitchen staff more of an understanding of what that person needs from their food,” she said.
“When you see someone who chews very slowly, or who tries very hard to chew something but ends up spitting it out because they can’t chew it, or even someone who coughs while eating their food because it has gone down the wrong way, you understand how important it is to get the food right,” Ms Cichero said.
“They learned that some people take 40 minutes to eat a meal, some people need to be fed because they can’t feed themselves, some people eat their food far too quickly causing frequent coughing or choking, and some people chew each mouthful for minutes before they can swallow it,” she said.
“That process is tiring, so tiring that they don’t eat everything on their plate and become malnourished,” Ms Cichero said.
“Looking at someone who is very frail and thin and seeing how little they eat, I’d like to think is very powerful to trying your best to make sure the food looks and tastes appealing, and also that it is a safe texture to eat,” said Ms Cichero.
Ms Cichero said that around 40-60 per cent of people in aged care have chewing or swallowing difficulties that could mean they need texture modified – puree, minced, soft and bite size – food or thickened drinks.
“The incidence of choking on food for people over the age of 65 years is seven times higher than it is for children aged one to four years of age,” she said.
“We know why we change the texture of babies and children’s food is to reduce choking risk. It’s the same thing as we get older.
“There are reports from Australian studies showing that choking is the second highest cause of preventable death in aged care facilities.
“Texture modified food is something that most healthy people are not used to seeing. It reminds people of baby food because it is pureed, or minced or chopped up. What many people don’t understand is that the food is changed in those ways (puree, minced, chopped) to reduce choking risk,” Ms Cichero said.
The kitchen staff also saw how difficult it was for residents to determine what they were actually eating.
“They saw that when pureed food is presented as ice cream ball scoops of white, green, orange and brown for example, that the people asked – what am I eating? Is that orange stuff carrot, or pumpkin? Is the green ball peas, broccoli, or beans? What is that brown stuff?,” Ms Cichero said.
“There is a common saying that ‘we eat with our eyes’. If you have a blob on your plate that you can’t identify, you’re probably not going to be interested in putting it in your mouth,” Ms Cichero said.
“An appreciation that the way the food was presented, and whether it smelled good and was tasty, affected how much people eat,” she said.
People on texture modified foods are more likely to struggle to meet their nutrition needs, and are more likely to lose weight. They are therefore likely to become malnourished, and therefore more susceptible to illnesses and for it to take longer for wounds to heal, Ms Cichero said.
Ms Cichero described a number of ways to make texture modified food more palatable.
“Using fresh ingredients and not over-cooking the food means that the food colour will be rich. Rich, vibrant colours are appealing,” she said.
“Finding appealing ways to present the food is important – that might be through food moulds where the food is shaped so that it looks like a piece of carrot, even if it is in fact pureed. It is important that the moulded food is not too sticky as sticky foods are a choking risk as well,” she said.
She said chefs in nursing homes can take inspiration from high-end chefs.
“Thinking about different ways of serving texture modified food taking some inspiration from high end chefs would be great too. Thinking of ways of layering purees, or using a creative smear of puree under some minced or bite-sized food.
“Using different food heights and textures – there are some lovely creative things happening with flavoured foams and dusts (like bacon dust or mushroom dust),” she said.
“Imagine scrambled eggs with bacon dust that actually tastes like you are eating bacon and eggs, but without the risk of choking on the bacon,” she said.
“There are chefs in Australia making these types of food and teaching other chefs to make them – it is not difficult and it makes such a difference.”
Ms Cichero said she’d love to see nursing homes chefs put the same kind of “love and care” that chefs put into their meals for restaurants.
She would like to see menus that describe the food, especially the texture modified food, and for there to be choice on those menus, she said.
“Aged care facilities are people’s homes, they are not hospitals. We need to find ways of involving residents in the food and the menus they are offered. While we need texture modified food for safety from choking risk, it needs to be prepared so that it looks appealing.
“There are many Michelin starred restaurants that serve food that would be suitable for texture modified diets – it’s all in the presentation and the way it is prepared.”