ADULT SPEECH PATHOLOGY

This newsletter is a joint collaboration between Adult Speech Pathology and Nutrition Professionals Australia.

MINCED & MOIST DIET- Level 5 (Orange)

A Minced & Moist diet may be recommended for a person who has difficulty chewing &/or swallowing some food consistencies.

Food in a Minced & Moist diet is soft, moist & easily mashed with a fork. Lumps are no larger than 4mm (the space between the tines of a fork) and are smooth & rounded. The texture should resemble mashed banana, or finely minced beef from the butcher. It should not be runny, sloppy, dry or crumbly.

Food needs to be well-cooked and minced in a mincer, or mashed well. It should be held together by a sauce/gravy so that small pieces do not separate in the mouth. It should require minimal chewing; tongue force alone is enough to break up the lumps.

This diet is little changed form the 'old' guidelines. The only change is to ensure the particle size is no more than 4mm. See the IDDSI website for more details.

TESTING for a MINCED AND MOIST DIET

Lumps should be no larger than 4mm. You can use the slot between the prongs of a fork to determine whether the minced pieces are too large as the standard size is conveniently 4mm.

When pressed with a fork, the particles should be easily separated between and come though the prongs of the fork. The food should be easily mashed with little pressure.

PUREED DIET- Level 4 (Green)

Pureed food & Extremely Thickened drinks have been linked in the IDDSI framework. They have the same characteristics & testing methods. They may be recommended for someone who has reduced tongue control and is unable to tolerate lumps in their food.

There are no changes within these levels from the previously used guidelines.

Food in a Pureed Diet is smooth, moist & lump free, and should hold together. The texture should resemble thick cream or mousse. It should not be runny or sloppy. It should show some very slow movement under gravity but cannot be poured. It should fall off a spoon in a single spoonful when tilted and continues to hold shape on a plate.

The food should not be able to be sucked through a straw and it must not be sticky.

EXTREMELY THICK FLUID- Level 4 (Green)

Extremely thick fluid should have essentially the same characteristics as the pureed diet. It does not flow or drip consistently through the prongs of a fork. A small amount may flow through the prongs of a fork and form a 'tail' below the fork prongs. The fluid should not be able to be sucked through a straw.

All thickened fluids must be prepared carefully using the instructions for the specific thickener used. All staff responsible for providing thickened fluids must have training in how to prepare the fluids correctly. 

Remember that if the fluid is too thin, there is an aspiration risk. If it is too thick, the resident is likely to drink less.

All thickened fluids must always be referred to by at least two identifiers:

  • colour & name / name & number / number & colour
  • e.g. Extremely Thick, Level 4, Green.

TESTING for PUREED DIET/ EXTREMELY THICK FLUIDS

POSTURE AND POSITIONING

The safest position for eating is sitting upright with 90° hip & knee flexion, feet supported, trunk & head in midline, head slightly flexed with chin down.

When a person is in this position the airway is more protected as the opening to the larynx (which leads to the lungs) is narrowed & the epiglottis is in more of an over-hanging position. When we don't use the correct positioning, the airway may be compromised.

As well as reducing the risk of aspiration (and thus pneumonia) and the risk of choking, the correct posture can also speed up digestion & reduce acid reflux.

For some individuals, physical support may be needed for the head or trunk. If a person is bed-bound, the head and neck should be well supported with neck slightly flexed. If the head is unstable, caregivers may even need to use a hand to support the person's forehead.

PRESENTING MINCED/ PUREED FOOD

We eat with our eyes. The presentation of food is an important factor in the acceptance of a meal and in how much we will eat. The minced and moist and pureed diets in particular are challenging. The visual appeal of the meal may be lacking.

It is important to avoid 'slop on a plate'. Molded food is ideal, but may not always be possible for some aged care homes. Even if you serve scoops, these can be presented well by carefully placing the scoops on the plate and serving the gravy in a separate jug. You may be able to add extra interest by piping the food, or adding a thickening agent and layering each individual item so that the dish can be presented as a 'terrine'.

Sometimes it can be easier to present cold snacks or desserts using simple silicone molds that are found in the supermarket. Add thickener to the puree, add to the mold and freeze. Even simply using a nice bowl or dish can make a big difference.

The minced and pureed items should follow the menu, and staff must be aware of what the dish actually consists of so that they can inform the resident. And remember that staff must be instructed to never mix the items together into one homogeneous mass. 'Would I eat that?' is the question we must ask ourselves.

 

 MEAL PLANS FOR OLDER PEOPLE

NPA's new Meal Plans Manual is a benchtop guide to nutrition care and therapeutic or special diets when catering for older people.

It provides a summary of nutrition for an older person, information regarding menu planning as well as a meal plan for each of the various special diets that are likely to be encountered. 

Many of these special diets eg diabetic and texture modified diets are routinely provided from the main menu, but others will need to be catered for on an individual basis.

The meal plans provide a simple and practical guide that can be readily referred to at the time of serving meals.

Also included in this manual is information regarding standard serve sizes and a standard menu structure to ensure that residents are provided with ample opportunities to choose foods from each of the core food groups and to ensure that the organisation meets Best Practice and/ or Accreditation Guidelines.

ONLINE RESOURCES

 

Online e-learning Presentations

Have you attended NPA's Improving Nutrition in Aged Care Seminar? We are now offering the seminars as a series of online e-learning presentations.

Read more

Resources for Aged Care

NPA has developed a set of resources and information for aged care homes.You can begin accessing  the NPA resources from our website now.

Read more

 

www.npagroup.com.au