Menu modification: Therapeutic and texture modification

FNS200

Long term care

• where adults live and recieve support for some or all daily activities

  • access to 24 hour nursing and personal care

• Growing snr population leads to more people requiring that kind of care

Retirement home

• Indpendent living, privately owned

• no 24 hour nurse

• may have assisted living or memory care floors

• meal plans are commons but the suites usually have their own kitchenettes

Acute-care

• provide necessary treatment for disease or episode of illness for a short period of time 

• discharge as soon as they are healthy and stable 

Why are therapeutic and texture mod diets important in recipe development

• things like dysphaga → trouble swallowing

• allow everyone to eat

  • can be changes in ingredients

  • makes food safe for everyone

Non-therapeutic diet 

• Designed to accommodate religious observances and dietary patterns that align with values

  • vegan, halal etc

Therapeutic

• diets that are required to prevent or treat certain medical or metabolic disorders and or provide a consistent level of nutrients 

  • low GI diet for individuals with diabetes 

  • Gluten free, low sodium etc 

• Doctors share what the issue is and dietitians come up with the meals that they will be served 

Texture modified diets

• Primarily used by those with dysphagia (difficulty swallowing)

• Can be used in 

  • sore gums

  • poor fit dentures

  • broken or missing teeth

  • temporary measure because of head or neck injury

  • temporary for broken jaw 

Considerations for texture modified diets

• protein and nutrient intake

  • >40% of residents in LTC are on TMDs 

• Addition of thickener can change the nutrient content 

  • addition of bulk to food as well as the body has more trouble absorbing nutrients from the thicker substance

• All textures should meet the nutrient requirement

• Should still plate nicely so that the patients meals look appitizing

• education of staff 

• recipe standardization and production methods matter

  • want texture mod to be as similar to the original as possible 

Chopped

• can be interpreted in different ways when no measurement is given 

• ensure that you are following the directions and size required by patients

IDDSI

• International dysphagia diet standardization initiative 

• Gold standard for dysphagia diet 

  • makes all the food safe and has methods for thickness testing 

Canadian IDDSI reference group

• launched in 2019 so has not been fully adopted 

• some still go with the international standards instead 

Levels in the IDDSI

Bottom to top 

• Drinks 

  • 0 = thin 

  • 1 = slightly thick

  • 2 = mildly thick

• Both

  • 3 = moderately thick /liquidized 

  • 4= extremely thick /pureed 

• Foods 

  • 5 = minced and moist

  • 6 = soft and bite sized

  • 7 = regular and easy to chew

Transitional foods in the IDDSI

• 7 = regular easy to chew

• 6 = Soft and bite sized 

• 5 = minced and moist 

IDDSI objectives

• to standardize terminoloty, definitions and testing methods to describe TMDS

  • avoid confusion and sometimes fatal outcomes of individuals recieving different textures when moving in healthcare settings 

Thickened fluids

• level of thickness that a patient requires is determined through assessment

• Items that melt are by default not complient because they will become thin when they melt 

  • temperature changes will cause issues for patients

Thickened milk

• must be called dairy beverage not milk because of standards 

Outsourced products 

• pre-purchased

  • can save time and resources

  • taste and texture wil always be the same

  • will have higher costs to procure the items

  • it reduces the amount of skilled labour that oyu have

Texture mod takeaways

• IDDSI is new and has not been fully implimented in many healthcare settings 

• we have to consider the quality of texture modified meals 

• it is important to provide foods that are as similar to regular diets as possible

• degree of modification depends on the ability to chew or swallow 

• must be guidelines in place for all diet textures 

• organizations must have policies and procedures to support patients not accept them to be on the texture that has been recommended for them 

Patient/resident diet orders

• always solid and liquid texture that is required 

  • Pureed, thin or minced and mildly thick 

• If appropriate will also include other non-therapeutic and or therapeutic diet 

• May or may not use the IDDSI language depending on how far they are implementing it 

Therapeutic diet examples

• diabetic, cardiac, renal, low fat, high energy/high protein, post-gastrectomy, gluten-free, hypermesis 

Therapeutic menus in retirement or long term care

• may see fewer restrictions and more liberalized diets 

• lactose reduced, no sugar added, high fibre 

Therapeutic menus In acute-care

• can see many therapeutic menus depending on the are of care 

• specialty menus 

  • low iodine, low tyramine, PET scan 

Who is responsible for menu planning therapeutic diets

• dietitians 

• nutrition targets influenced by 

  • legislation 

  • organizational policies/procedures 

  • patient demographics

  • negotiated contracts (contract food service)

Menu planning - therapeutic and TMDs

• must have adequate resources for the range of therapeutics the facility provides 

• ideal in the plannign stage to think abotu items htat can be served across several diets 

  • selecting milk alternatives for vegan diet

• consider how production, menu ttype, service type can contribute to recipe modification 

level 0

• flows liek water

• easily through straw

• less than 1ml remaining in syringe after 10 secondsof flow

Level 1

• slightly thick

• thicker than water but can still flow through straw easily

• 1-4mL remaining in syringe after 10 seconds of flow

Level 2

• mildly thick

• sippable from a cup but effort is needed to drink this through a straw

• 4-8mL remaining in syringe after 10 seconds of flow

Level 3

• moderately thick (liquid)

• Liquidized (foods)

• can be eaten with a spoon or drank from a cup

• would slowly drip through a fork

• effort would be needed to drink this through a large straw

• no less than 8mL remaining in syringe after 10 seconds of flow

  • slow drips through prongs of fork

Level 4

• extremely thick (liquid)

• pureed (food)

• smooth with no lumps nut sticky

• no chewing needed

• can be eaten with a spoon

  • sits in mound or pile above the fork

  • does not dollop or drip continuously through a fork

  • holds shape on a spoon

  • falls easily if spoon is tilted

  • not firm or sticky

Level 5

• Minced and moist

• very soft small moist lumps

• limited chewing required

• 4mm lump sized for adults and 2mm for children

  • holds shape on a spoon falls off easily if flicked or tilted

  • not firm or sticky

Level 6

• Soft and bite sized

• tender and moist throughout

• no think liquid leaking or dripping from food

• requires chewing ability

  • no bigger than 1.5×1.5 cm for adults and 8mm for children

  • push down on piece with fork

    • sample should squash completely and not regain its shape

Level 7 - easy

• easy to chew

• normal foods or soft foods

• developmentally appropriate

• requires biting and chewing ability

Level 7 regular

• regular foods

• normal foods of various textures that require. biting and chewing ability