Issues and Challenges of Modified-Texture Foods in Long-Term Care: A Workshop Report : Page 3 of 3
The MTF Research Planning Workshop sought to identify, interpret, and set priorities on key themes emerging from work conducted on MTFs in LTC facilities. We reached a consensus that a better understanding of the prevalence of malnutrition, particularly undernutrition, and the use of commercially and in-house prepared MTFs in LTC facilities is needed to provide segue into further research. Fortification of MTFs with supplemental vitamins and minerals is an additional area for consideration. Future studies should focus on interprofessional, multicenter collaborations that provide large enough sample sizes to demonstrate statistically and clinically significant changes, while remaining sensitive to LTCs being “home” environments for their residents. Laboratory research should be used whenever possible to answer some key MTF research questions in preparation for clinical research. Reliable and validated tools are required that are sensitive in identifying changes in outcome measures, such as satisfaction, weight gain or loss, and food intake, and that can be used in both cognitively intact and cognitively impaired populations. Additional factors, including the physiology of aging, dysphagia, overall mealtime experience, need for feeding assistance, standardization of MTF production and delivery, and cost of MTFs, must be considered when determining the feasibility, sustainability, and policy implications of using MTFs in LTC facilities.
Funding for the Modified-Texture Food Research Planning Workshop was provided in part by the Canadian Institutes of Health Research Meeting, Planning and Dissemination Grant, and a grant from the Bruyère Research Institute.
1. Furman EF. Undernutrition in older adults across the continuum of care: nutritional assessment, barriers, and interventions. J Gerontol Nurs. 2006;32(1):
2. Allard JP, Aghdassi E, McArthur M, et al. Nutrition risk factors for survival in the elderly living in Canadian LTC facilities. J Am Geriatr Soc. 2004;52(1):59-65.
3. Dyck MJ, Chumacher JR. Evidence-based practices for the prevention of weight loss in nursing home residents. J Gerontol Nurs. 2011;37(3):22-33.
4. Stratton RJ, Hackston A, Longmore D, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults. Br J Nutr. 2004;92(5):799-808.
5. Keller H. The development of Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN). Can J Diet Pract Res. 2000;61(2):67-72.
6. Shatenstein B, Kergoat MJ, Nadon S. Weight change, nutritional risk and its determinants among cognitively intact and demented elderly Canadians. Can J Public Health. 2001;92(2):143-149.
7. Crogan NL, Pasvogel A. The influence of protein-calorie malnutrition on quality of life in nursing homes. J Gerontol A Biol Sci Med Sci. 2003;58(2):159-164.
8. Hall G, Wendin K. Sensory design of foods for the elderly. Ann Nutr Metabl. 2008;52(suppl 1):25-28.
9. Mioche L, Boudiol, Peyron MA. Influence of aging on mastication: effects on eating behavior. Nutr Res Rev. 2004;17(1):43-54.
10. Kendall K, Sinacori J, Tulunay-Ugur O. Challenges and opportunities in the management of dysphagia. Otolaryngol Head Neck Surg. 2010;143(suppl 2):P30-P31.
11. Keller HH, Chambers LW, Niezgoda H, Duizer L. Issues associated with the use of modified-texture foods. J Nutr Health Aging. In press.
12. Stewart L. Development of the Nutrition and Swallowing Checklist, a screening tool for nutrition risk and swallowing risk in people with intellectual disability. J Intellect Dev Disabil. 2003;28(2):171-187.
13. Reuben DB. Quality indicators for the care of undernutrition in vulnerable elders. J Am Geriatr Soc. 2007;55(suppl 2):S438-S442.
14. Dahl WJ, Whiting SJ, Tyler RT. Protein content for pureed diets: implications for planning. Can J Diet Pract Res. 2007;68(2):99-102.
15. Beck AM, Hansen KS. Meals served in Danish nursing homes and to Meals-On-Wheels clients may not offer nutritionally adequate choices. J Nutr Elderly. 2010;29(1):100-109.
16. Wright L, Cotter D, Hickson M, Frost G. Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet. J Hum Nutr Diet. 2005;18(3):213-219.
17. Stodel EJ, Chambers LW. Assessing satisfaction with care in LTC homes: current and best practices. Healthc Manage Forum. 2006;19(3):45-52.
18. Kumlien S, Axelsson K. Stroke patients in nursing homes: eating, feeding, nutrition and related care. J Clin Nurs. 2002;11(4):498-509.
19. Ney DM, Weiss JM, Kind AJH, Robbins J. Senescent swallowing: impact, strategies and interventions. Nutr Clin Pract. 2009;24(3):395-413.
20. Colodny N. Dysphagic independent feeders’ justifications for noncompliance with recommendations by a speech-language pathologist. Am J Speech-Language Pathol. 2005;14(1):61-70.
21. Chou SC, Boldy DP, Lee AH. Measuring resident satisfaction in residential aged care. Gerontologist. 2001;41(5):623-631.
22. Keller HH, Laurie CB, McLeod J, Ridgeway N. Development and reliability of the Mealtime Social Interaction Measure for Long-Term Care (MSILTC). http://jag.sagepub.com/content/early/2012/01/03/0733464811433841.abstract. Accessed June 28, 2012.
23. Keller HH, Dupuis S, Schindel-Martin L, Edward G, Genoe R, Cook C. The “Eating Together” Study. Ontario, Canada: Kenneth G. Murray Alzheimer Research and Education Program, University of Waterloo, 2006. www.marep.uwaterloo.ca/PDF/fall06.pdf. Accessed July 6, 2012.
24. Keller H, Dupuis S, Schindel Martin L, Genoe R, Reimer H, Edward G, Cassolato C. Mealtimes as “the way we are”: the meaning and experience of meal times in the dementia context. J Nutr Health Aging. 2009;13(Suppl 1):S522..
25. Reimer H, Keller H, Schindel Martin L, Dupuis S, Genoe R, Edward G. Applications of the Life Nourishment Theory in early stage dementia. Presented at: 39th Annual Scientific and Education Meeting, Canadian Association of Gerontology; December 4-6, 2010; Montreal, Quebec, Canada.
26. Carrier N, West GE, Ouellet D. Cognitively impaired residents’ risk of malnutrition is influenced by food service factors in long-term care. J Nutr Elder. 2006;25(3-4): 73-87.
27. Cormier D, Harper DW, O’Hara PA, et al. Puréed diet: prevalence and reported reasons for use in a long-term care hospital. J Can Diet Assoc. 1994;55(3):121-124.
28. Kumlien S, Axelsson K. Stroke patients in nursing homes: eating, feeding, nutrition and related care. J Clin Nurs. 2002;11(4):498-509.
29. Durant M. A comparison of energy provision by diet order in a long-term care facility. Can J Aging. 2008;27(2):225-227.
30. Wright L, Cotter D, Hickson M, Frost G. Comparison of energy and protein intakes for older people consuming a texture modified diet with a normal hospital diet. J Human Nutr Diet. 2005;18(3):213-219.
31. Dahl WJ, Whiting SJ, Tyler RT. Protein content of puréed diets: implications for planning. Can J Diet Pract Res. 2007;68(2):99-102.
32. Adolphe JL, Whiting SJ, Dahl WJ. Vitamin fortification of puréed foods for long-term care residents. Can J Diet Pract Res. 2009;70(3):143-150.
33. Genoe MR, Keller HH, Martin LS, et al. Adjusting to mealtime change within the context of dementia. Can J Aging. 2012;31(2):173-194
34. Dahl WJ, Whiting SJ. Textural characteristics of institutional and commercial pureed foods. J Am Diet Assoc. 2003;103(suppl 9):208-209.
35. Hall G, Wendin K. Sensory design of foods for the elderly. Ann Nutr Metab. 2008;52(suppl 1):25-28.
36. Parent M, Niezgoda H, Keller HH, Chambers LW, Daly S. Comparison of visual estimation methods for regular and modified textures; real-time vs. digital imaging. J Acad Nutr Diet. In press.
The authors report no relevant financial relationships.
Address correspondence to:
Helen Niezgoda, BScN, MSc
Bruyère Research Institute
43 Bruyère Street
Ottawa, Ontario, Canada K1N 5C8