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Recommendations Summary

UWL: Collaboration for Modified Texture Diets 2009

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  UWL: Collaboration for Modified Texture Diets

  The Registered Dietitian (RD) should collaborate with the speech-language pathologist and other healthcare professionals to ensure that older adults with dysphagia receive appropriate and individualized modified texture diets.  Older adults consuming modified texture diets report an increased need for assistance with eating, dissatisfaction with foods, and decreased enjoyment of eating, resulting in reduced food intake and weight loss.

  Rating: Strong
  Conditional

  • Risks/Harms of Implementing This Recommendation

    • Patient denial or misclassification of the necessary dysphagia diet may result in aspiration pneumonia due to poor swallowing function

  • Conditions of Application

    • These recommendations apply to older adults with dysphagia consuming modified texture diets.
    • Facilities may not have access to a speech-language pathologist.
    • Food service staff should be trained to prepare and serve foods according to modified texture diet guidelines.

  • Potential Costs Associated with Application

    • Modified texture diets may include specialized preparation techniques, special foods and liquids that may be costly.

  • Recommendation Narrative

    • Seven studies were evaluated regarding the use of modified texture diets in older adults with dysphagia. 
    • People consuming modified texture diets report an increased need for assistance with eating, dissatisfaction with foods, and decreased enjoyment of eating, resulting in decreased food intake and weight loss (Ekberg et al, 2002; Nowson et al, 2003; Colodny, 2005; Wright et al, 2005; Foley et al, 2006; Lorefalt et al, 2006).
    • Recognition of the social and psychological burden of dysphagia, an individualized treatment approach and the provision of eating assistance may contribute to increased food intake and weight maintenance or weight gain (Rypkema et al, 2004).
    • Interventions may include but are not limited to:  standard high-energy diet change or protein-energy supplements in malnutrition, swallowing therapy, rehydration, better positioning, and individualizing meal timing (Rypkema et al, 2004).

  • Recommendation Strength Rationale

    • Conclusion Statement in support of these recommendations received Grade I.

  • Minority Opinions

    Consensus reached.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  What is the relationship between modified texture diets and weight gain in adults over age 65?

  • References

    Colodny N.  Dysphagic independent feeders' justifications for noncompliance with recommendations by a speech-language pathologist.  Am J Speech Lang Pathol 2005;14(1):61-70. 
    
    Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P.  Social and psychological burden of dysphagia:  its impact on diagnosis and treatment.  Dysphagia 2002;17:139-146. 
    
    Foley N, Finestone H, Woodbury MG, Teasell R, Greene-Finestone L.  Energy and protein intakes of acute stroke patients.  J Nutr Health Aging 2006;10(3):171-5. 
    
    Lorefalt B, Granerus AK, Unosson M.  Avoidance of solid food in weight losing older patients with Parkinson's disease.  J Clin Nurs 2006;15(11):1404-12. 
    
    Nowson CA, Sherwin AJ, McPhee JG, Wark JD, Flicker L.  Energy, protein, calcium, vitamin D, and fibre intakes from meals in residential care establishments in Australia.  Asia Pacific J Clin Nutr 2003;12(2):172-77. 
    
    Rypkema G, Adang E, Dicke H, Naber T, De Swart B, Disselhorst L, Goluke-Willemse G, Olde Rikkert M.  Cost-effectiveness of an interdisciplinary intervention in geriatric inpatients to prevent malnutrition.  J Nutr Health Aging 2004;8(2):122-7. 
    
    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):213-9.