Texture-modified diets

To ensure texture-modified meals are safe, appetising and nutritious, older adults’ preferences, presentation, aroma, meal contents and eating support are important aspects to consider. Aged care cooks and chefs may require further training on how to create nutritious and appetising meals with varying texture-modifications using the allocated budget and kitchen equipment. Collaboration between aged care staff and allied health professionals to assess swallowing difficulties and changes to levels of texture modification is necessary to provide safe meals for older adults needing modified diets. 

When reviewing your texture-modified meal plans you might want to consider the following: 

• Levels of texture-modification – Australia follows the International Dysphagia Diet Standardisation Initiative for standards of texture-modification levels. Liquids range from 0-thin to 4-extremely thick with instructions on how to test the liquid using the Spoon Tilt test. [1] Food modifications range from 7-regular/easy to chew to 3-liquidised. [2] To deliver modifications correctly, training for cooks, chefs, carers, nurses and kitchen hands is crucial.
• Increasing the appeal – Older adults are more likely to consume and enjoy a texture-modified meal if moulds are used to reshape the food or food is piped in different shapes and patterns, food is layered, regular cutlery is provided, the menu includes items which are already texture-modified (e.g., chocolate mousse), foods are separated on the plate, food is clearly labelled, spices are added for extra flavour and aroma, and height is added (e.g., in ramekins rather than on a plate). [3]
• Involving allied health professionals – Speech Pathologists who assess swallowing and recommend texture-modified diets as a strategy for management, and Dietitians which assess nutritional needs and advise foods to maximise nutrient intake, are valuable professionals to call upon to continually assess older adults and advise meal plans in aged care settings.

If you are considering reviewing your texture-modified meal plan, the following resources may provide useful support: 

• Aged Care Quality and Safety Commission video - Food, dining and nutrition webinar - Swallowing, texture-modified diets and nutrition
• A fact sheet for aged care staff - Nutrition and texture modified food and drink 
• Maggie Beer Foundation - Rethinking texture modified foods module 
• A fact sheet for aged care staff – Supporting safe and enjoyable mealtimes for people with swallowing difficulties including information on how to respond to signs of swallowing difficulties, when to refer for an assessment and implementing a mealtime support plan
• Presenting texture-modified foods to create an appetising eating experience

Quality Standards

The Aged Care Quality and Safety Commission are currently consulting on draft guidance resources to help providers, aged care workers and other stakeholders to understand the new strengthened Quality Standards and their roles and responsibilities in meeting them. Along with the new Aged Care Act, the strengthened Quality Standards are expected to be introduced from 1 July 2024.

For Information:

Draft Provider Guidance Standard 6 - Food and Nutrition
https://www.agedcarequality.gov.au/resource-library/draft-provider-guidance-standard-6

 Want to know more?

If you require more information on implementing an approach to delivering tasty, safe and nutritious meals in aged care: 

1. Browse the nutrition resources. 

2. Look for research evidence within the PubMed database by using one of the PubMed searches provided here. PubMed contains brief information (‘citations’) on millions of research studies. It can therefore be challenging to search. Our librarian has made finding highly relevant information on this topic as simple as a click of a button. Click on All to see everything in the database on the topic or choose Full text to view only articles immediately available to you free of charge in full text.